Brain resuscitation in the drowning victim

Details

• Personal Author:
  Berg RA ; Branche CM ; Clark RS ; Friberg H ; Gierens JJLM ; Hoedemaekers CWE ; Holzer M ; Katz LM ; Knape JTA ; Kochanek PM ; Nadkarni V ; Topjian AA ; van der Hoeven JG ; Warner DS
• Description:
  Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidencebased consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 oC) considered. Arterial hypotension/ hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brainoriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/ reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders. [Description provided by NIOSH]
• Subjects:
  Biomarkers Cardiovascular Diseases Cardiovascular System Epidemiology Hypothermia Nervous System Nervous System Diseases Occupational Health Safety
• Keywords:
  Asphyxia Author Keywords: Drowning Brain Brain-damage Brain-function Cardiac-function Cardiac Arrest Central-nervous-system Electroencephalography Hyperthermia Monitoring-systems Neurological-system

  More +
• ISSN:
  1541-6933
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  District of Columbia ; OSHA Region 3 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OD - Office of the Director
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  441-467
• Volume:
  17
• Issue:
  3
• NIOSHTIC Number:
  nn:20041838
• Citation:
  Neurocrit Care 2012 Dec; 17(3):441-467
• Contact Point Address:
  Alexis Topjian, The Children's Hospital of Philadelphia, 7th floor, 34th Street and Civic Center Boulevard, Suite 7C23, Philadelphia, PA 19104
• Email:
  Topjian@email.chop.edu
• Federal Fiscal Year:
  2013
• Peer Reviewed:
  True
• Source Full Name:
  Neurocritical Care
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d72acddff1959cca6bca67ac8aecbae1bcaf8fe117d7a375e19feabb95d8ee3fc60dd5e5511f0edd7d17839949c098ff90e2b953ba8a22b576bc122318d429eb
• Download URL:
  https://stacks.cdc.gov/view/cdc/194287/cdc_194287_DS1.pdf
• File Type:
  [PDF - 808.24 KB ]