Pediatric Cold Fresh Water Drowning

Pediatric Cold Fresh Water Drowning in a Portland Metro Area Case Study Summary

This 4-year-old boy got away from his mother and disappeared near an area where Johnson Creek meanders and drains the foot hills of the Cascade mountains in Clackamas County on its way to the Willamette River. 

This happened during the winter time. While the mother looked frantically for her son, a Metro bus driver in Clackamas County was showing her son the bus route when he noticed a small body floating down the creek. She stopped the bus, and her son pulled the boy, floating face down, from the creek and started CPR while his mother called 911. A land ambulance arrived 10 minutes later, continued CPR, and took the boy directly to the Trauma OR at Emanuel Hospital, where a cardiopulmonary bypass machine and cardiothoracic surgeon were waiting. This boy had no signs of life and his ECG was flatline. The prehospital time was over 1 ½ hours.

Because of previous successful experiences with cold fresh water drowning, we asked the trauma anesthesiologist to intubate the patient while we performed a median sternotomy to cannulate the child’s right atrium and ascending aorta to initiate cardiopulmonary bypass (CPB) with oxygen and to rewarm the patient. After 10 minutes, the boy’s pupils went from fixed and dilated to reactive, and heart began to beat. Gradually his heart recovered and we no longer needed inotropic support. (We don’t use cardiovascular constrictor drugs as the CPB would perfuse all the organs and tissues without them.)   

His abdomen became very taut from all the intraabdominal organ swelling. The anesthesiologist decompressed with a nasogastric tube inserted into the boy’s stomach and removed the swallowed water, while we made an abdominal silo to decompress the abdomen.

He recovered quickly. We closed his chest and weaned him off CPB in 4 hours. We were able to extubate him two days later, as he was breathing spontaneously, moving all limbs, and following simple commands.

We were concerned about anoxic brain damage. We asked a pediatric neurologist to evaluate the boy. We obtained an EEG which showed normal brain activity, and an MRI scan which showed normal brain anatomy. 

After a few more days, before we sent him to pediatric rehabilitation, he was walking in the hallways holding his mother’s hand. One month later, the report came back that physically he had no disabilities and he was only one year behind his peer group intellectually.

Take home message: With the development of portable ECMO and CPB machines that are easily primed and readily available to meet all the patient’s oxygen and perfusion needs, the ability to rapidly provide this support system may change the outcomes of pediatric drowning victims.

To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline.

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