What is the prognosis of drowning?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Patients who are alert or mildly obtunded at presentation have an excellent chance for full recovery. Patients who are comatose, those receiving CPR at presentation to the emergency department (ED), or those who have fixed and dilated pupils and no spontaneous respirations have a poor prognosis. In a number of studies, 35-60% of individuals needing continued CPR on arrival to the ED die, and 60-100% of survivors in this group experience long-term neurologic sequelae.

Pediatric studies indicate that mortality is at least 30% in children who require specialized treatment for drowning in the pediatric intensive care unit (PICU). Severe brain damage occurs in an additional 10-30%.

The neuroprotective effects of cold-water drowning are poorly understood. Intact survival of comatose patients after cold-water submersion is still quite uncommon. A 2014 study challenged the idea of improved survival in cold water drowning. [66] Hypothermia in nonwinter probably means they were immersed longer and thus have a worse outcome. [67]

Hypothermia profoundly decreases the cerebral metabolic rate, but neuroprotective effects seem to occur only if the hypothermia occurs at the time of submersion and only if very rapid cooling occurs in water with a temperature of less than 5°C (eg, if the individual broke through ice into the water).

Morbidity and death from drowning are caused primarily by laryngospasm and pulmonary injury, resulting hypoxemia and acidosis, and their effects on the brain and other organ systems. A high risk of death exists secondary to the subsequent development of acute respiratory distress syndrome (ARDS).

The adult mortality rate is difficult to quantify because of poor reporting and inconsistent record keeping. Thirty-five percent of immersion episodes in children are fatal; 33% of episodes result in some degree of neurologic impairment, with 11% resulting in severe neurologic sequelae.

Anecdotal reports of survival are noted in children with moderate hypothermic submersion (core temperature < 32°C), but most persons experiencing cold-water submersion do not develop hypothermia rapidly enough to decrease cerebral metabolism before severe, irreversible hypoxia and ischemia occur.


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