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A technique called in-water resuscitation (IWR) was devised on a surfboard to ventilate persons who seemingly did not breathe upon a water rescue. Despite IWR still raises uncertainties regarding its applicability, this technique is recommended by the International Liaison Committee for Resuscitation (ILCOR). Thus, this study aimed to evaluate the feasibility of IWR with a rescue board before and during towing and, to compare rescue times and rescue-associated fatigue levels between rescues with rescue breath attempts and without (SR). A randomized crossover pilot test was conducted: 1) IWR test with pocket mask and, 2) Conventional SR test. IWR tests were conducted using a Laerdal ResusciAnne manikin (Stavanger, Norway). Three groups of variables were recorded: a) rescue time (in s), b) effective ventilations during rescue, and c) rating of perceived effort (RPE). Focusing on the rescue time, the performance SR was significantly faster than IWR rescue which took 61 s longer to complete the rescue (Z = −2.805; p = 0.005). No significant differences were found between techniques for the RPE (T = −1.890; p = 0.095). In the IWR analysis, lifeguards performed an average of 27 ± 12 rescue breaths. The application of IWR on a rescue board is feasible both at the time of rescue and during towing. It shortens the reoxygenation time but delays the arrival time to shore. Both IWR and SR result in similar levels of perceived fatigue.

Scedosporium aurianticum infection developed in 2 recipients of kidney transplants in India, acquired from the same deceased near-drowning donor. Given the substantial risk for death associated with Scedosporium infection among solid-organ transplant recipients, safety protocols for organ transplantation from nearly drowned donors should be thoroughly revaluated and refined.

Drowning is a leading cause of injury-related death worldwide, but there are limited data on the management and disposition of asymptomatic and mildly symptomatic adults and children following a drowning event. Some authors have recommended admission for all drowning victims due to the possibility of respiratory and clinical deterioration in a seemingly well patient. In order to identify predictors for admission and to establish a unified approach for management, we retrospectively collected all children ≤ 16 years old presented following a drowning event to the pediatric ED over a period of 12 years. The children were divided into two groups, those who were discharged home from the ED and those who were admitted. Seventy-one surviving and non-intubated children were asymptomatic to moderately symptomatic, and they comprised the study group. Crepitations on lung auscultation, oxygen desaturation, and respiratory distress were significantly higher in the admitted group (n = 26) compared with the discharged group (n = 45) (P < 0.05). Respiratory distress and lung crepitations were independent predictors for admission. Eventually, 30% of the hospitalized patients required oxygen therapy, but there were no cases that deteriorated and required invasive ventilation. No readmissions occurred in the group of children who were discharged from the ED.Conclusion: Children who after six hours show no respiratory distress and have normal oxygen saturation and normal auscultation can be safely discharged home. Respiratory distress and lung crepitations should both warrant the physician to consider admission of asymptomatic to moderately symptomatic children following a drowning event. An algorithm to assist patient management is proposed.What is Known:•There are few data in the literature regarding the management and disposition of asymptomatic to moderately symptomatic children after drowning.What is New:•We found that respiratory distress and lung crepitations are independent predictors for admission. An algorithm to assist patient management is proposed.

Due to the difficulty in making the decision to discontinue resuscitation efforts, clinicians often perform prolonged cardiopulmonary resuscitation (CPR) in children who have drowned. This study investigated the relationship between out-of-hospital CPR duration and neurological outcomes in children with drowning-induced cardiac arrest. This retrospective cohort study used data from the All-Japan Utstein Registry from 2013 to 2021. We included patients aged ≤18 years with drowning-induced cardiac arrest who underwent CPR via emergency medical services. The study's primary outcome was a favorable neurological outcome (Cerebral Performance Category score of 1 or 2) at 1 month. We also calculated the dynamic proportion of 1-month outcomes as a function of out-of-hospital CPR duration. Moreover, we determined the sensitivity, specificity, and positive predictive value of 33 min of out-of-hospital CPR, which is the time point at which primary analysis showed a plateau in the neurological outcomes. Of 14,849 children included in the registry, 992 cases of drowning-induced cardiac arrest were analyzed. The median out-of-hospital CPR duration was 20 (range, 2–164) min, with only 35 (3.5 %) patients showing favorable neurological outcomes at 1 month. The proportion of favorable neurological outcomes decreased rapidly for up to 33 min of out-of-hospital CPR and then plateaued to 0.3 %; only three patients achieved favorable neurological outcomes after 33 min of CPR. An out-of-hospital CPR duration of >33 min was associated with poor neurological outcomes (sensitivity, 0.17 [95 % confidence interval: 0.15–0.20]; specificity, 0.91 [0.77–0.98]; and positive predictive value, 0.98 [0.95–1.00]). Prehospital EMS-initiated CPR duration for children with drowning-induced cardiac arrest was inversely associated with one-month favorable neurological outcomes. Favorable neurological outcomes after >33 min of out-of-hospital CPR were extremely rare, though accurately predicting the outcome remains challenging.

Background Near-drowning is a prevalent cause of hypoxic ischemic injury in children and young adults. Despite its clinical significance, there is a lack of studies examining the brain magnetic resonance imaging (MRI) findings associated with near-drowning incidents. Purpose The aim of this study is to identify patterns of imaging findings on brain MRI scans of children who have experienced near-drowning. Methods This retrospective study included children who experienced near-drowning incidents and had brain MRI scans available for review between November 2000 and September 2023. Abnormal MRI findings were categorized into three patterns: (1) gray matter injury, (2) white matter injury, and (3) combined gray matter and white matter injury. For each category, we distinguished those with MRI scans obtained in the acute setting and those with MRI studies performed in the non-acute setting. When available in the electronic medical records (EMR), collected parameters for patients with acute MRI scans included: sex, age, best estimate of the water temperature, water type, duration of submersion, and whether cardio pulmonary resuscitation (CPR) was performed. Results The study included 50 patients (32 males, 18 females) with a median age of 32.9 (interquartile range, 19.9–69.2) months. Of these patients, 28 had acute MRI scans available, while 22 had only non-acute MR imaging. Among the 28 patients with acute MRI, 12 (42%) had primarily cortical and/or deep gray matter injury without visible white matter injury, 8 (29%) had both cortical and/or deep gray and white matter injury, and 8 (29%) were normal. The median age was 26.7 (interquartile range, 16.6–43.6) months in the acute MRI group and 42.9 (interquartile range, 27-130.3) months in the non-acute MRI group. Water temperature information was available in 25/50 cases, all occurring in warm water (9 in a bathtub and 16 in a pool). In patients with isolated gray matter injury, the submersion duration was < 3 min in 7/12 patients, while 5/12 did not have data on submersion duration. CPR was performed in 8 patients, with data unavailable for 4 cases. In patients with gray and white matter injury, submersion duration was < 3 min in 1/8 cases, with data not available for 7 patients. CPR was performed in 5 patients, with data unavailable for 3 cases. In patients with normal findings the submersion duration was < 3 min in 2/8 patients, and CPR was performed in all 8 patients. Conclusion Our study suggests that children who suffer near-drowning are likely to have gray matter injury on MRI obtained within the first 7 days after injury. In contrast, delayed white matter lesions, may develop weeks after the initial hypoxic-ischemic event and may be observed in chronic imaging either alone or in combination with gray matter lesions. These imaging patterns appear to resemble those described in neonatal hypoxic-ischemic injuries, although further studies are needed to confirm these associations.

Scedosporium apiospermum species complex are widely distributed fungi that can be found in a variety of polluted environments, including soil, sewage, and decaying vegetation. Those opportunistic pathogens with strong potential of invasion commonly affect immunosuppressed populations However, few cases of scedosporiosis are reported in immunocompetent individuals, who might be misdiagnosed, leading to a high mortality rate. Here, we reported an immunocompetent case of systemtic infection involved in lung, brain and spine, caused by S. apiospermum species complex ( S. apiospermum and S. boydii ). The patient was an elderly male with persistent fever and systemtic infection after near-drowning. In the two tertiary hospitals he visited, definite diagnosis was extremely difficult. After being admitted to our hospital, he was misdiagnosed as tuberculosis infection, before diagnosis of S. apiospermum species complex infection by the metagenomic next-generation sequencing. His symptoms were alleviated after voriconazole treatment. In the present case, the details associated with its course were reported and published studies on Scedosporium spp. infection were also reviewed, for a better understanding of this disease and reducing the misdiagnosis rate.

AimTo examine the burden and risk factors for fatal and non-fatal drowning in India.MethodsRelevant literature was identified through a systematic search of 19 electronic databases and 19 national and global, institutional, organisational and government sources of injury data. Search terms used pertained to drowning, injury, trauma, morbidity and mortality in India.ResultsA total of 16 research articles and five data sources were included in the review. Three national data sources provided counts of drowning deaths, reporting a range of 1348–62 569 drowning deaths per year. A further three national data sources provided information on drowning-related morbidity; however, each source presented different outcome measures making comparison difficult. Ten research studies investigated risk factors associated with drowning in India. Key risk factors reported were male gender, young age (0–5 years) and individuals residing in the North-Eastern part of the country who have high exposure to water sources within community settings.ConclusionDrowning-related morbidity and mortality have a significant impact on India, with risk factors identified for this setting similar to those within other low-income and middle-income countries. Regional data which look beyond routinely collected data are required to accurately investigate the burden and impact of drowning, to inform targeted, context-specific approaches for drowning reduction initiatives

The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance. A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards. Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube. The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.

ObjectiveTo investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital.DesignA prospective cohort study of near-drowning children.Setting95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia.Participants23 children both met the criteria and had parental consent for the study.Main outcome measuresIdentification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF.Result95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up.ConclusionChildren admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.

Background Scedosporium apiospermum ( S. apiospermum ) is a rare fungal pathogen that causes disseminated infections. It rarely affects immunocompetent individuals and has a poor prognosis. Case presentation A 37-year-old woman presented with multiple lesions in the lungs, brain, and eyes, shortly after near drowning in a car accident. The primary symptoms were chest tightness, limb weakness, headache, and poor vision in the left eye. S. apiospermum infection was confirmed by metagenomic next-generation sequencing (mNGS) of intracranial abscess drainage fluid, although intracranial metastases were initially considered. After systemic treatment with voriconazole, her symptoms improved significantly; however, she lost vision in her left eye due to delayed diagnosis. Conclusion While S. apiospermum infection is rare, it should be considered even in immunocompetent patients. Prompt diagnosis and treatment are essential. Voriconazole may be an effective treatment option.