What are guidelines for temperature management in cold-water drowning patients?

Updated: Jun 19, 2019
  • Author: G Patricia Cantwell, MD, FCCM; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

It was suggested that resuscitation of a submersion victim not be abandoned until the patient has been warmed to a minimum of 30°C. However, newer literature, based on extensive preclinical modeling of cellular response to ischemia and reperfusion injury, as well as analyzing long-term outcome, suggests that therapeutic hypothermia can be effective in reducing ischemic brain injury. [80, 91]  Therapeutic hypothermia improves oxygen supply to ischemic brain areas, decreases cerebral metabolic demand, and decreases increased intracranial pressure.

At least 4 separate case reports of drowning victims who experienced full neurologic recovery after coma and cardiac arrest suggest that therapeutic hypothermia may confer neuroprotection. [81, 101, 102] This area needs additional vigorous clinical research to determine the most efficacious treatment strategy. In the interim, it would appear appropriate for individual jurisdiction EMS directors to meet with their local referral hospital(s) to determine current temperature management strategy.

The panel of experts at the 2002 World Congress on Drowning [5] made the following consensus recommendations on drowning management: "The highest priority is restoration of spontaneous circulation, subsequent to this continuous monitoring of core/and or brain (tympanic) temperatures is mandatory in the ED and intensive care unit and to the extent possible in the prehospital setting. Drowning victims with restoration of adequate spontaneous circulation who remain comatose should not be actively warmed to temperature values above 32º-34°C. If core temperature exceeds 34°C, hypothermia should be achieved as soon as possible and sustained for 12 to 24 hours..." Evidence to support the use of any neuroresuscitative pharmacologic therapy is insufficient.


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