From the Guidelines
Immediate treatment for near-drowning involves removing the person from water, checking for breathing and pulse, and starting CPR if needed, with a focus on restoring breathing as much as circulation, as stated in the 2024 American Heart Association guidelines 1. The primary goal is to address hypoxia, the leading cause of morbidity and mortality in drowning cases.
Key Steps in Treatment
- Remove the person from the water and call emergency services immediately
- Check for breathing and pulse, and start CPR if the person is unresponsive, with 30 chest compressions followed by 2 rescue breaths, as recommended by the American Heart Association 1
- For an unconscious victim who is breathing, place them in the recovery position (on their side with head tilted back)
- Provide oxygen therapy and consider intubation for respiratory support once medical help arrives
- Hospital treatment includes monitoring oxygen levels, managing fluid in the lungs, treating hypothermia if present, and addressing potential complications like pneumonia or brain injury
Importance of Prompt Medical Evaluation
Even if a drowning victim appears recovered, they should still be evaluated medically as complications can develop hours later (secondary drowning), as noted in the 2020 American Heart Association guidelines 1. The duration and severity of hypoxia sustained as a result of drowning is the single most important determinant of outcome, highlighting the need for prompt rescue and resuscitation efforts 1.
Resuscitation Techniques
Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique, and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment, as updated in the 2024 guidelines 1. Routine stabilization of the cervical spine in the absence of circumstances that suggest a spinal injury is not recommended, as it may delay needed resuscitation, according to the 2020 American Heart Association guidelines 1.
From the Research
Treatment for Near-Drowning
The treatment for near-drowning, also known as submersion incident, involves several key steps to address the primary pathophysiological mechanism of drowning, which is the development of acute hypoxia 2. The following are the main components of treatment:
- Rescue procedure: careful pulling the victim out of the water, examination, maintenance of the airways passable, and urgent transfer to hospital 2
- Provision of ventilation: increases the chances of survival, and should be started immediately by the lay rescuer, along with chest compressions and cycles of ventilations and compressions 2
- Basic life support: training bystanders to provide basic life support and apply automated external defibrillator in a drowning person whenever indicated and as early as possible 2
- Advanced life support: includes early intubation, cervical spine immobilization, establishment of ventilation with oxygen, emergency transport, and application of reanimation and advanced vital support measures 2, 3
Hospital Treatment
In the hospital setting, the primary focus is on managing the associated clinical concerns, such as:
- Hypothermia: rewarming the patient 4, 5
- Mechanical ventilation: to optimize oxygenation and achieve an intrapulmonary shunt ≤ 20% or Pao2:Fio2 ≥ 250 3
- Traumatic injuries: treatment of any associated injuries 4
- Observation: asymptomatic patients with normal vital signs, oxygenation, and chest radiographs require only 4 to 6 hours of observation, while many near-drowning victims will require at least 24 hours of observation 5
Response Strategies
The response strategies for drowning incidents involve: