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Three Part Question

In patients who [have nearly drowned] does [therapeutic hypothermia] [improve neurological outcomes or reduce mortality]?

Clinical Scenario

A 20-year-old male is rushed to the Emergency Department after falling into a canal. He is unresponsive and suffers a cardiac arrest for which CPR is commenced. You wonder if therapeutic hypothermia may have a role in his management.

Search Strategy

Medline 1946 to June week 2 2015 and Embase 1980 to 2015 week 25 using the OVID interface.
Medline: [exp Near Drowning/ OR exp Drowning/ OR drowning.mp. OR drown$.mp.] AND [exp induced hypothermia/ OR therapeutic hypothermia.mp.] LIMIT to human AND English Language.

Embase: [exp Near Drowning/ OR exp Drowning/ OR drowning.mp. OR drown$.mp.] AND [exp induced hypothermia/ OR therapeutic hypothermia.mp.] LIMIT to human AND English Language.

The Cochrane Library Issue 6 of 12 date of searching 04/07/2015 : MeSH descriptor: [Drowning] explode all trees.

Search Outcome

Altogether 33 papers were identified by the Medline search strategy and 60 by the Embase search strategy. Of these 1 paper was considered relevant to the three-part question. No relevant reviews were found in the Cochrane library.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Choi SP et al 2012 Korea	20 consecutive adult patients aged 17-72 with cardiac arrest due to drowning admitted between 2005-2008, in whom CPR had been started, and who were treated with induced hypothermia to a target temperature 32-34° .	Retrospective review of records	Favourable neurological outcome	n=4 (20%)	Retrospective, small number of patients used. Method of therapeutic hypothermia not standardized for all patients.
			Vegetative state at discharge	n= 2 (10%)
			Death	n=14 (70%) Only significant factor predictinpredicting outcome was prolonged ACLS (P=0.035)

Comment(s)

Although there are case reports suggesting some use for therapeutic hypothermia in near drowning, the only current study finds that there is no advantage to therapeutic hypothermia over conventional treatment in adults with cardiac arrest after near drowning. Further prospective studies with larger patient groups are needed to evaluate this therapy.

Editor Comment

BF

Clinical Bottom Line

There is currently little evidence to suggest a benefit to therapeutic hypothermia over conventional treatment in drowning victims with cardiac arrest.

References

1. Choi SP, Youn CS, Park KN et al. Therapeutic hypothermia in adult cardiac arrest because of drowning. Acta Anaesthesiol Scand 2012; 56: 116-123