A systematic review of interventions for resuscitation following drowning
Joost J.L.M. Bierens, Janet Bray, Cristian Abelairas‐Gómez, Roberto Barcala‐Furelos, Stephen Beerman, Andreas Claesson, Cody Dunne, Tatsuma Fukuda, Muralidharan Jayashree, Anthony T. Lagina, Lei Li, Tom Mecrow, Patrick Morgan, Andrew Schmidt, Jeroen Seesink, Justin Sempsrott, David Szpilman, Ogilvie Thom, Joshua M. Tobin, Jonathon Webber, Samantha Johnson, Gavin D. Perkins
Abstract
Objectives: The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods: The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results: = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion: The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.