Table of contents
Near-drowning
What's new
Updated 2024 AHA/AAP guidelines for resuscitation after drowning.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of near-drowning are prepared by our editorial team based on guidelines from the American Heart Association (AHA/AAP 2024), the American Heart Association (AHA 2020), the Wilderness Medical Society (WMS 2019), and the British Thoracic Society (BTS 2017).
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Diagnostic investigations
CXR
As per WMS 2019 guidelines:
Recognize that initial CXR findings do not correlate with arterial blood gas measurements or outcomes.
B
Consider obtaining CXRs to track changes in patient condition, but not for determining prognosis if obtained at the time of presentation.
B
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Neuroimaging
Laboratory tests
Respiratory support
Oxygen supplementation: as per AAP/AHA 2024 guidelines, provide supplemental oxygen, if available, by trained rescuers to patients with cardiac arrest following drowning.
B
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Noninvasive positive pressure ventilation
Mechanical ventilation
Medical management
Rescue: as per WMS 2019 guidelines, attempt rescue from a safe location by reaching, throwing, or rowing to the drowning patient if not formally trained in water rescue.
B
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In-water resuscitation
CPR
Management of hypothermia
Management of VF
Indications for evacuation
Antibiotic therapy
Corticosteroids
Therapeutic procedures
Cervical spine immobilization: as per AHA 2020 guidelines, do not perform routine stabilization of the cervical spine in the absence of circumstances suggesting a spinal injury.
D
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Heimlich maneuver
Therapeutic hypothermia
Specific circumstances
Preventative measures
Participant education and training: as per WMS 2019 guidelines, counsel patients with coronary artery disease, prolonged QT syndrome or other ion channel disorder, autism, seizure disorders, or other medical and physical impairments about the increased risk of drowning and about steps to mitigate the risk, such as buddy swimming and rescue devices, should they choose to participate in water activities.
B
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Personal flotation device
Presence of lifeguards
Follow-up and surveillance
Quality improvement
Rescuer training: as per AAP/AHA 2024 guidelines, implement a competency-based training program with regular retraining and maintenance of equipment to optimize rescue breathing using equipment (bag-mask or advanced airways).
B
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Public access defibrillation