PROGNOSTIC FACTORS AND LONG-TERM OUTCOMES FOR CHILDREN WHO HAVE NEARLY DROWNED

Objective: To find predictors of outcome and to describe the long term outcome for children who require mechanical ventilation after nearly drowning. Patients and setting: From 1981 to 1989, all children who un derwent ventilation in the Intensive Care Unit of the Mater Children's Hospital, Brisbane, after an immersion. Children who died within 24 h ours were excluded. Of 57 children eligible for entry, 18 died after 2 4 hours. Design: Retrospective study of hospital records and prospecti ve assessment of neurodevelopmental outcome. Thirty-eight families of survivors were contacted by questionnaire and 25 children of these fam ilies were examined. Follow-up was between 0.8 and 9.6 years after imm ersion. Results: All children who had a motor response to pain in the hospital's emergency department survived without sequelae. Thirty-one children were in cardiac arrest and, of these, 17 died, six survived w ith severe spastic quadriplegia and eight are ambulant. Of those ambul ant, four have motor coordination difficulties and three have learning difficulties. Children in cardiac arrest who had a delay of more than 20 minutes between rescue and arrival at hospital were more likely to die or sustain severe spastic quadriplegia. No child survived if more than 25 minutes of advanced resuscitation was required after they had been warmed. Conclusions: Children with a motor response to pain seem to have a good prognosis. However, we could not predict which childre n in cardiac arrest would die or survive either severely impaired or a mbulant. All children in cardiac arrest should receive aggressive resu scitation for at least 25 minutes after being warmed; they have a bett er prognosis if advanced resuscitation is started less than 20 minutes after rescue. Children who survive a cardiac arrest without spastic q uadriplegia warrant long term surveillance as they may have coordinati on and learning difficulties.