What are the guidelines for CPR and care in a drowning victim?

Guidelines for CPR and Care in Drowning Victims

In cardiac arrest following drowning, CPR with rescue breaths and chest compressions should be provided to all persons immediately after removal from the water. 1 This approach is critical because the primary mechanism of cardiac arrest in drowning is hypoxia, making rescue breathing particularly important for successful resuscitation.

Initial Assessment and Rescue

• When attempting to rescue a drowning victim:
  • Ensure rescuer safety first
  • Remove the victim from water as quickly as possible
  • Routine cervical spine immobilization is NOT recommended unless there are specific circumstances suggesting spinal injury 1
  • Immediately assess for breathing and consciousness

CPR Protocol for Drowning Victims

For Healthcare Providers:

1. Use the A-B-C approach (Airway-Breathing-Compressions) rather than the standard C-A-B sequence 1

   • This modification is specifically recommended for drowning victims due to the hypoxic nature of the arrest
   • May check pulse for up to 10 seconds before initiating CPR

2. Rescue Breathing:

   • Open airway
   • Provide 2 rescue breaths that make the chest rise
   • If trained and safe to do so, in-water rescue breathing may be reasonable before removing victim from water 1

3. Chest Compressions:

   • If no pulse is definitely felt after rescue breaths, begin chest compressions
   • Follow standard BLS compression rate and depth
   • Provide supplemental oxygen if available 1

4. AED Use:

   • Apply AED once victim is removed from water if pulseless
   • Do not delay CPR to obtain or apply an AED 1
   • Defibrillate if shockable rhythm is identified

For Lay Rescuers:

• Provide CPR with rescue breaths and chest compressions 1
• If unable or unwilling to provide rescue breaths, compression-only CPR is reasonable until help arrives 1
• Do not attempt to clear water from airways using abdominal thrusts or Heimlich maneuver 1

Managing Complications During Resuscitation

Vomiting:

• If vomiting occurs (common in drowning victims):
  • Turn victim to the side
  • Remove vomitus using finger, cloth, or suction
  • If spinal injury is suspected, logroll as a unit (head, neck, torso together) 1

Hypothermia:

• Continue resuscitation efforts even in hypothermic patients
• Prolonged CPR may be beneficial in drowning victims with hypothermia 2, 3

Post-Resuscitation Care

• All victims requiring any form of resuscitation (including rescue breathing alone) should be transported to the hospital for evaluation and monitoring 1
• Monitor for at least 4-6 hours even if initially alert and demonstrating effective cardiorespiratory function 1

Prevention Strategies

• Implementation of Public Access Defibrillator (PAD) programs is reasonable in aquatic environments with:
  • High population density
  • Frequent utilization
  • Long distances to nearest AED 1

Important Caveats

• Do not attempt to remove water from the breathing passages by any means other than suction
• Victims with only respiratory arrest usually respond after a few artificial breaths
• Successful resuscitations have been reported after prolonged submersion, so scene resuscitation should be initiated unless there are obvious signs of death 1
• Prolonged CPR (>30 minutes) may be warranted in select drowning patients, especially those who had a pulse at any point during evaluation 2