Effect of prehospital respiratory interventions on pediatric drowning outcomes

Background: Initial respiratory management is critical during drowning resuscitation. We studied the effect of prehospital airway adjuncts and supplemental oxygen on pediatric drowning outcomes. Methods: This cross-sectional study was a sub-analysis of children 0–18 years old who presented post-drowning to one of 32 pediatric emergency departments from 2010 to 2017. Submersion and clinical data were obtained from prehospital and medical records. Patients were categorized based on presence of out-of-hospital cardiac arrest (OHCA). Airway adjuncts included prehospital bag-valve mask (BVM) or endotracheal intubation for OHCA patients and supplemental oxygen or room air in non-OHCA patients. Primary outcomes were survival or favorable neurological outcomes at hospital discharge using Cerebral Performance Category. Covariates included demographics, body of water, bystander CPR, submersion duration, and witnessed drowning. Outcomes were compared by cardiac arrest status and respiratory intervention using logistic regression. Results: There were 3188 patients (No OHCA: 2975 (93%); OHCA: 213 (7%)). Median age was 3.3 years (IQR: 2.0, 5.6); 61% were male. Among OHCA patients, intubation did not have significantly different odds of favorable neurological outcome [aOR: 0.6 (95%CI: 0.1, 3.5)] or survival [aOR: 2.0 (95%CI: 0.6, 7.2)] at hospital discharge compared to BVM. No significant difference in outcomes occurred in non-cardiac arrest patients based on provision of prehospital supplemental oxygen. Conclusion: In pediatric patients in OHCA following drowning, endotracheal intubation was not associated with significantly different odds of favorable neurological outcome or survival at hospital discharge compared to BVM. No differences in outcomes also occurred in non-OHCA patients based on provision of prehospital supplemental oxygen.