Accidental drowning stands as the third most frequent cause of unintentional deaths worldwide resulting in almost 7% of the world’s mortality. According to WHO, drowning is one of the major causes of death and it results in about 320,000 deaths in a year. And this all is happening within a few seconds! However, there are some measures that one can take to prevent such instances, and one of them is the provision of CPR.
But, does a normal CPR performed differently for drowning victims? Yes, they do!
In this blog post, we will discuss the standard CPR process recommended for patients who have drowned: There are some significant deviations from the normal CPR process which are important to know and why, to make a drowning victim’s chances of survival possible.
Key Differences Between Basic CPR and Drowning CPR
While the basic principles of CPR remain the same, there are several important differences when performing CPR on drowning victims:
Remove the victim from water first: Before initiating the CPR on the victim, be sure that he or she is pulled out of the water and to a dry area. This is because during this stage the rescuer may be attacked and the victim may also voluntarily resist, this stage generally should be very safe.
Initial assessment for breathing: Unlike basic CPR where immediately after the onslaught we check for pulse, in a drowning incident the emphasis is on breathing. One aspect is to observe movements of the chest, to listen for breath sounds, and to palpate the breath from the nose or mouth.
Start with rescue breaths: For drowning persons, the BLS (Basic Life Support), which uses Airway, Breathing, then Compressions is more effective than the traditional CAB (Compression, Airways, Breathing) sequence.
Before beginning chest compressions, use five sets of breaths with the mouth over the victim’s mouth. This is mainly the case because the main issue in drowning is hypoxia rather than hypoxic-ischemic encephalopathy.
Modified compression-to-breath ratio: In case of adult casualties, the involved ratio is 30 compressions and 2 breaths. With the kids and infants, use the 15:2 if the ratio is two rescuers involved in the process.
Be prepared for regurgitation: People who drown risk associating respiratory failure with aspiration of water so there are high chances of vomiting during CPR. When the victim becomes restless, he/she may start vomiting; it will be necessary to rotate the head to the side frequently.
Continue CPR until help arrives: It is recommended that even if the victim has returned to what seems normal, you should go on practising CPR until the emergency services arrives. Secondary drowning may happen hours after the near-drowning event.
Special Considerations for Drowning Victims
When performing CPR for drowning victims, there are several additional factors to keep in mind:
Potential for vomiting and aspiration:
Drowning stresses people, which raises the chances of vomiting when performing CPR on the victims. Be ready and able to rapidly tilt the victim’s head to the side should they start to vomit. When the mouth is cleared continue to perform the CPR straight without any interruption. Never try to towel the patient and expel water from the lungs but try to open the airway and make way for air by giving him/ her rescue breaths.
Hypothermia risks:
Survivors of drowning and particularly those that drown in cold water are more prone to hypothermia. Get rid of wet clothes, if doable, and place dry clothes on the victim. Keep on doing CPR even if the victim seems to be cold or blue; victims of cold water drowning may be revived no matter how long it takes. Bear in mind that hypothermia reduces the heart rate and may thus make it difficult to identify a pulse.
Spinal injury precautions:
In any case there is a suspicion of head or neck injury (for instance, diving), it is prohibited to move head and neck. Replace the head-tilt/chin-lift manoeuvre with jaw-thrust method in clearing the airway. If possible, have another person use your head and neck restraint during CPR.
Saltwater vs. freshwater considerations:
In contrast with older guidelines, there is no distinction in the interventions recommended to treat saltwater vs. freshwater submersion—which means that the primary emphasis should not be highly placed on the kind of water being used to perform the activity; however, the main aim should be on oxygenation and circulation.
Foam in the airway:
Drowning victims may also have foam in the mouth and nose since the mouth will contain water, air and lung secretions. Do not skip CPR to remove this foam; go on with the rescue breaths and chest compressions.
Extended CPR duration:
There are reports of people being successfully resuscitated after apparently hours of CPR in drowning, particularly in cold water related incidents. Perform CPR till professional help arrives that is even in case it seems to be of insignificant benefit.
The ABC and CAB approach
The general CPR guidelines have in the recent past been slightly changed from the ABC model to the less known CAB model. Nevertheless, in cases of CPR drowning, it is a somewhat different case that proves the ABC approach more beneficial.
- CAB Approach (Standard CPR):
- Used for most cardiac arrest situations
- Prioritizes chest compressions to maintain blood flow
- Compressions, Airway, Breathing
- ABC Approach (Traditional and for Drowning):
- Traditionally used and still recommended for drowning victims
- Prioritizes airway clearance and breathing
- Airway, Breathing, Compressions
- Why ABC May Benefit Drowning Cases:
- Lack of oxygen due to water in the lungs
- Allows for immediate delivery of oxygen to the lungs
- Can help stimulate breathing reflexes in some cases
- Implementation in Drowning CPR:
- Start with 5 initial rescue breaths
- Then alternate between 30 chest compressions and 2 rescue breaths
- Continue this cycle until professional help arrives or signs of life appear
Although the CAB approach prevails as the standard protocol for most CPR circumstances, drowning emergencies would benefit from a revival of the ABC method. This strategy targets the main cause of oxygen depletion in the drowning victims and can be fundamental in altering results.
Myths Regarding Drowning CPR
In CPR for drowning victims, there are many myths that can be misleading in terms of treatment to be provided including the following: Let’s address some of these myths:
Myth: Before starting the CPR you will have to make sure that all the water has been drained from the lungs.
Reality: It is pointless and even counterproductive to try to remove water from the lungs; time is lost in doing so. Water accumulation in the lungs is usually not a lot and does not pose a problem to the effectiveness of CPR. Pay attention to the fact that it is possible to start CPR and rescue breaths right away.
Myth: It is only a few minutes after the victim has been submerged in water that he or she can no longer be rescued.
Reality: Resuscitation has been reported to have been done even after certain hours of drowning particularly when the drowning was in cold water. Perform CPR and do not stop until help comes even if the person was submerged in water for a given time.
Myth: If someone is coughing and breathing when they are being rescued then they are safe.
Reality: Secondary drowning may happen even after some hours from the incident. It is recommended to get medical assistance irrespective of the condition of the individual involved in near-drowning incidents.
Myth: To remove the water out of your system you should try the Heimlich manoeuvre.
Reality: The Heimlich manoeuvre should not be used with drowning victims as it is dangerous. It does not efficiently drain water from the lungs and it can be rather counterproductive.
Myth: Drowning in salt water is more lethal than drowning in fresh water.
Reality: In the present CPR guidelines, there are no differences between the cases of marine or freshwater submersion. The first and the most crucial is to oxygenate the water, and the type of water does not matter.
Myth: If there is frothy discharge from the mouth, then CPR will not be helpful.
Reality: Foam is found in the lungs of drownings and does not inhibit proper CPR. Go on with the rescue breaths and compressions even if there is foam present.
Myth: CPR cannot be done under water.
Reality: Although it is advisable to take the victim to a firm ground, if this cannot be done then in-water CPR is allowed. In the water, if chest compressions cannot be done, then give emphasis on the rescue breaths.
Myth: CPR is always effective if performed correctly.
Reality: CPR is vital however the results are influenced by factors such as the time spent underwater and the temperature of the water. All those who drowned will not get a chance to live even with proper and appropriate CPR measures.
By avoiding these myths, we can ensure that bystanders and first responders are better prepared to provide effective assistance in drowning emergencies. Remember, the key is to act quickly, start with rescue breaths, and continue CPR until professional help arrives.
Importance of Proper Training
While understanding the theory behind CPR for drowning victims is valuable, it’s crucial to emphasise the importance of proper, hands-on training:
Certified CPR Courses: Certified CPR courses should be the only offered courses because they offer participants the opportunity to practise compression as well as rescue breath on mannequins. These courses also describe a number of situations, for example, procedures concerning drowning, and frequently contain information about the utilisation of Automated External Defibrillators (AEDs), so the participants of these courses would be ready to manage different kinds of emergencies.
Regular Skill Updates: Skill update is very important because the CPR guidelines change with the new research findings. If the rescuer does not perform CPR frequently, the skills may get rusty and that is the reason that most certifications require renewal every one to two years. It also helps individuals to update the knowledge of the procedures they do routinely and thus can maintain their skills up to date.
Confidence in Emergency Situations: Getting trained in performing CPR helps build the confidence of an individual in case of an emergency and reduces the likelihood of hesitation. They are more likely to do cpr rightly when under pressure owing to muscular memory and thus become willing bystander rescuers.
Learning to Assess Situations: CPR training involves imparting knowledge on how one is able to move very fast and first assess a certain situation as an emergency so that one may be in a position to determine when and how to evacuate in order to parachute. This skill is quite useful especially in case of an emergency where speed and efficiency in a particular action is very vital.
Learn About Drowning CPR
CPR for drowning victims, while based on the same life-saving principles as standard CPR, does involve some crucial differences and special considerations. Let’s recap the key points:
- The primary issue in drowning is oxygen deprivation, not cardiac arrest, which is why the ABC (Airway, Breathing, Compressions) approach is often preferred over the CAB method.
- Start with 5 initial rescue breaths before beginning chest compressions.
- Be prepared for complications such as vomiting, hypothermia, and potential spinal injuries.
- Continue CPR until professional help arrives, even in cases of prolonged submersion.
- Common myths about drowning CPR can lead to ineffective treatment, so it’s crucial to understand the correct procedures.
Remember, while this information is valuable, it’s no substitute for proper CPR training. We strongly encourage everyone to take a certified CPR course and to keep their skills updated regularly. In an emergency, quick action with proper technique can make the difference between life and death.
