EFFECT OF IMMEDIATE RESUSCITATION ON CHILDREN WITH SUBMERSION INJURY

Study objective. To determine the effect of immediate resuscitative ef forts on the neurological outcome of children with submersion injury. Design. A case-control study was designed to determine if immediate re suscitation by rescuers or bystanders reduces the frequency of severe neurological damage or death in children with a documented submersion event. Logistic regression was used calculate an adjusted odds ratio. Participants. The study group consisted of 166 children, aged zero to 14 years, having a submersion event during May 1984 through August 199 5 and admitted through various emergency departments to Huntington Mem orial Hospital in Pasadena, California. Measurements and main results. All study subjects had an observed and documented episode of apnea at the time of submersion. Outcomes were evaluated on the basis of neuro logical impairment or death. Exposure was verified from historical acc ounts of postsubmersion events provided by family, friends, and/or par amedical personnel. The study factors included age and gender, duratio n of submersion, hypothermia, presence of apnea, resuscitative efforts , and clinical outcome. Children with a good outcome were 4.75 (adjust ed odds ratio (OR)) times more likely to have a history of immediate r esuscitation than children with poor outcome (95% confidence interval: 3.44 < OR < 6.06, P =.0001). Various types of resuscitative efforts a nd potential confounding factors were also evaluated. CPR and mouth-to -mouth resuscitation were the most effective types for the prevention of death or severe anoxic encephalopathy. Conclusion. Immediate resusc itation before the arrival of paramedical personnel is associated with a significantly better neurological outcome in children with submersi on injury.