Objectives: At present, there is no reliable information indicating the best option of rescuing a non-breathing drowning victim in the water. Our objectives were to compare the outcomes of performing immediate in-water resuscitation (IWR) or delaying resuscitation until the victim is brought to shore.
Material and methods: A retrospective data analysis was conducted of non-breathing drowning victims rescued by lifeguards in the coastal area of Rio de Janeiro, Brazil. Patients were coded as IWR and no-IWR (NIWR) cases based on the lifeguard's decision whether to perform IWR. Death and development of severe neurological damage (SND) were considered poor outcome.
Results: Forty-six patients were studied. Their median age was 17 (9-31) years. Nineteen (41.3%) patients received IWR and 27 (58.7%) did not. The mortality rate was lower for IWR cases (15.8% versus 85.2%, P < 0.001). However, among surviving IWR cases, 6 (31.6%) developed SND. In multivariate analysis, higher age [odds ratio (OR) = 1.12 (95% confidence interval (CI) = 1.01-1.24), P = 0.038] was associated with death, while IWR [ OR = 0.05 (95% CI = 0.01-0.50), P = 0.011] was protective. When death or the development of SND was set as the dependent variable, longer cardiopulmonary arrest (CPA) duration was the unique variable selected (OR = 1.77 (95% CI = 1.13-2.79), P = 0.013]. Every patient with CPA duration higher than 14 min had a poor outcome.
Conclusions: Delaying resuscitation efforts were associated with a worse outcome for non-breathing drowning victims. In the cases studied, IWR was associated with improvement of the likelihood of survival. An algorithm was developed for its indications and to avoid unnecessary risks to both victim and rescuer.