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Neurocritical Care
Published in: Neurocritical Care 3/2012

01-12-2012 | Review Article

Brain Resuscitation in the Drowning Victim

Authors: Alexis A. Topjian, Robert A. Berg, Joost J. L. M. Bierens, Christine M. Branche, Robert S. Clark, Hans Friberg, Cornelia W. E. Hoedemaekers, Michael Holzer, Laurence M. Katz, Johannes T. A. Knape, Patrick M. Kochanek, Vinay Nadkarni, Johannes G. van der Hoeven, David S. Warner

Published in: Neurocritical Care | Issue 3/2012

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Abstract

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32–34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders.
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Metadata
Title
Brain Resuscitation in the Drowning Victim
Authors
Alexis A. Topjian
Robert A. Berg
Joost J. L. M. Bierens
Christine M. Branche
Robert S. Clark
Hans Friberg
Cornelia W. E. Hoedemaekers
Michael Holzer
Laurence M. Katz
Johannes T. A. Knape
Patrick M. Kochanek
Vinay Nadkarni
Johannes G. van der Hoeven
David S. Warner
Publication date
01-12-2012
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 3/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-012-9747-4

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