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Children 2018, 5(1), 4; https://doi.org/10.3390/children5010004

Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome: A Case Report and Literature Review

1
Department of Pediatrics, Division of Psychology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA
2
Programs for Evaluation, Development and Learning, St. Charles Healthcare Systems, Bend, OR 97701, USA
3
Department of Pediatrics, Division Pediatric Neurology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA
4
Department of Pediatrics, Division Pediatric Critical Care, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA
*
Author to whom correspondence should be addressed.
Received: 30 November 2017 / Revised: 15 December 2017 / Accepted: 15 December 2017 / Published: 27 December 2017
Full-Text   |   PDF [187 KB, uploaded 27 December 2017]

Abstract

Drowning is the 3rd leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. Submersion injuries with cardiac arrest can lead to long-term neurologic morbidity. Severe hypothermic submersion injuries have complex treatment courses and survivors have variable neurocognitive outcomes. We describe the course of a hypothermic submersion injury in a 6-year-old previously healthy boy. The description includes premorbid and post-injury neurocognitive functioning. A review of the literature of pediatric cold-water submersion injury was performed. Despite prolonged cardiopulmonary resuscitation (>100 min) and water temperature well above freezing, our patient had an optimal neurocognitive outcome following hypothermic submersion injury. Available literature is limited but suggests that increased submersion time, increased duration of resuscitation, and higher water temperatures are associated with worse outcomes. Care guidelines have been created, but outcomes related to these guidelines have not been studied. Our case highlights potential important determinants of outcome after drowning. Incident specific characteristics and therapeutic interventions should be considered when evaluating this population. Treatment guidelines based on currently available literature may fail to incorporate all potential variables, and consideration should be given to prolonged resuscitative efforts based on individual case characteristics until further data is available. View Full-Text
Keywords: drowning; hypothermia; out-of-hospital cardiac arrest; neuropsychological tests; outcome assessment; critical care outcome; pediatric drowning; hypothermia; out-of-hospital cardiac arrest; neuropsychological tests; outcome assessment; critical care outcome; pediatric
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Kriz, D.; Piantino, J.; Fields, D.; Williams, C. Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome: A Case Report and Literature Review. Children 2018, 5, 4.

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