Bierens, Joost, Bray, Janet, Abelairas-Gomez, Cristian, Barcala-Furelos, Roberto, Beerman, Stephen, Claesson, Andreas, Dunne, Cody, Fukuda, Tatsuma, Jayashree, Muralidharan, T Lagina, Anthony, Li, Lei, Mecrow, Tom, Morgan, Patrick, Schmidt, Andrew, Seesink, Jeroen, Sempsrott, Justin, Szpilman, David, Thom, Ogilvie, Tobin, Joshua, Webber, Jonathon, Johnson, Samantha, and Perkins, Gavin D. (2023) A systematic review of interventions for resuscitation following drowning. Resuscitation Plus, 14. 100406.

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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: Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 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.

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