Childhood near-drowning: is cardiopulmonary resuscitation always indicated?

The case histories of 93 consecutive pediatric near-drowning victims admitted to All Children's Hospital from 1983 to 1987 were retrospectively reviewed for patient status on ED arrival and eventual outcome. Age, sex, length of submersion, core temperature, pHa, absence of spontaneous respiration, lack of response to pain, and pupillary nonreactivity were all found to be unreliable predictors of outcome. Of those who received CPR, 68% went on to intact survival. The use of cardiotonic medicines to establish a perfusing cardiac rhythm in the initial resuscitation was associated with an eventual outcome of severe neurologic damage or death in all instances. The decision to use cardiotonic medicines in the resuscitation of pediatric near-drowning victims should be weighed carefully against their ultimate chances of intact survival.