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Citation
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Markarian T, Loundou A, Heyer V, Marimoutou C, Borghese L, Coulange M, Michelet P. Chest 2020; ePub(ePub): ePub. |
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Affiliation
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Emergency Department, Timone University Hospital, C2VN, Aix-Marseille University, Marseille, France. |
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Abstract
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BACKGROUND: Drowning still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. Over the last decades, considerable efforts have been made to improve prevention and care. It seemed appropriate to reassess the prognosis and clinical presentation of drowned patients more than 20 years after this first publication. The aim of our study was to provide a reappraisal of patients who needed advanced health care and a precise description of their respective neurological, respiratory, and hemodynamic profiles.
METHODS: This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in Intensive Care Units (ICU) located in France, French Polynesia, and French Antilles. Patients were classified following the drowning classification system proposed by Szpilman.
RESULTS: During the study period, 312 drowned patients were admitted with severe clinical presentation (Grade 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (Emergency Medical Services), starting from the prehospital period. Although the global hospital mortality was similar to previously reported (18.5%), great differences existed among severity grades. Respective grades' mortalities were low for Grade 2-5 (Grade 2 - 0%; Grade 3 - 3%; Grade 4 - 0%; Grade 5 - 2%) as the mortality for Grade 6 remained similar to previously reported (54%). Our results confirmed that the occurrence of a cardiac arrest after drowning still pejorative. Conversely, for other grades, our study strengthens the importance of specialized intervention to interrupt the drowning process.
CONCLUSION: Based on our results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.
Copyright © 2020. Published by Elsevier Inc.
Language: en |