Resuscitation and emergency care in drowning: A scoping review

Abstract

Background

The ILCOR Basic Life Support Task Force and the international drowning research community considered it timely to undertake a scoping review of the literature to identify evidence relating to the initial resuscitation, hospital-based interventions and criteria for safe discharge related to drowning.

Methods

Medline, PreMedline, Embase, Cochrane Reviews and Cochrane CENTRAL were searched from 2000 to June 2020 to identify relevant literature. Titles and abstracts and if necessary full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on the population (adults and children who are submerged in water), interventions (resuscitation in water/boats, airway management, oxygen administration, AED use, bystander CPR, ventilation strategies, ECMO, protocols for hospital discharge (I), comparator (standard care) and outcomes (O) survival, survival with a favourable neurological outcome, CPR quality, physiological end-points).

Results

The database search yielded 3242 references (Medline 1104, Pre-Medline 202, Embase 1722, Cochrane reviews 12, Cochrane CENTRAL 202). After removal of duplicates 2377 papers were left for screening titles and abstracts. In total 65 unique papers were included. The evidence identified was from predominantly high-income countries and lacked consistency in the populations, interventions and outcomes reported. Clinical studies were exclusively observational in nature.

Conclusion

This scoping review found that there is very limited evidence from observational studies to inform evidence based clinical practice guidelines for drowning. The review highlights an urgent need for high quality research in drowning.

Introduction

Drowning is the third leading cause of unintentional injury-related death worldwide.¹ The annual reported death toll from drowning likely represents the tip of the iceberg of total drowning incidents which occur globally.

Nearly twenty years ago, in partnership with the International Liaison Committee on Resuscitation (ILCOR), the Utstein drowning collaborators developed a standardised framework for the reporting of drowning incidents.² The framework, updated in 2017,³ aimed to accelerate research and improve consistency of reporting outcomes related to drowning. In 2005 ILCOR developed consensus on science and treatment recommendations for drowning related to in-water resuscitation, removing victims from the water and adjuncts to ventilation.⁴ More recently, ILCOR focused on the evidence base informing search and rescue operations.5, 6 Despite increasing research in drowning, synthesis of the available research to inform evidence based practice guidelines has been limited.

The ILCOR Basic Life Support Task Force and the international drowning research community considered it timely to undertake a scoping review of the literature to identify any new evidence related to this topic. A scoping rather than a systematic review was conducted in order to systematically map the published, peer reviewed literature as this was considered the most appropriate methodology in an area with limited research.⁷ At the same time, such a systematic mapping would identify gaps in knowledge related to resuscitation of victims of drowning. Nine high priority domains were selected for review covering initial resuscitation, hospital-based interventions and criteria for safe discharge. The Population, Intervention, Comparator and Outcomes considered are summarised in Table 1.