Elsevier

Resuscitation

Volume 65, Issue 3, June 2005, Pages 321-324
Resuscitation

In-water resuscitation: a pilot evaluation

https://doi.org/10.1016/j.resuscitation.2004.12.002Get rights and content

Abstract

Introduction:

The first and most important treatment for the apnoeic drowning victim is the rapid alleviation of hypoxia by artificial ventilation. Recent studies have suggested that commencing resuscitative efforts with the victim still in the water may be beneficial. The aim of this pilot study was to evaluate the feasibility and efficacy of in-water unsupported rescue breathing.

Methods:

Three lifeguards were taught how to perform in-water unsupported rescue breathing. Ventilation volume, inflation duration were recorded from a modified Laerdal resuscitation manikin. The rescue duration was recorded and compared to a rescue undertaken without in-water resuscitation.

Results:

The three lifeguards performed between seven and nine ventilations during each simulated rescue. This gave average inflation volumes for each lifeguard of 711 ml (S.D. 166), 750 ml (S.D. 108), 629 ml (S.D. 182) and average inflation duration of 0.8 s (S.D. 0.3), 0.9 s (S.D. 0.2) and 0.6 s (S.D. 0.1). The rescue duration was increased from an average time of 1 min 10 s to 1 min 24 s by performing in-water resuscitation.

Conclusion:

This study has demonstrated the feasibility and potential efficacy of in-water unsupported rescue breathing with a victim in deep water. Furthermore, the technique was not associated with an undue prolongation of the rescue duration over a 50 m rescue. In circumstances where the trained lifeguard finds themselves with an apnoeic victim in the water, with no buoyant rescue aid available, they may consider the application of in-water, unsupported rescue breathing, especially if recovery to dry land is likely to be delayed. The effectiveness of this technique, however, remains to be proven in the open water environment.

Introduction

The first and most important treatment for the apnoeic drowning victim is the rapid alleviation of hypoxia by artificial ventilation [1]. Previous studies have reported that the prompt initiation of rescue breathing is associated with improved survival in submersion victims [2]. Szpilman and Soares have recently shown the feasibility and potential benefits of commencing resuscitation with the drowning victim still in the water [3]. Various techniques to enable resuscitation to be performed in water have been described. These include the use of a buoyant rescue aid [3], [4], [5] to support the casualty whilst undertaking rescue breathing, mouth to snorkel in-water resuscitation [1] and resuscitation using an emergency diving regulator [6], [7]. The formal evaluation of these techniques is limited with the available literature being largely descriptive. In particular, the technique of unsupported in-water rescue breathing, when the victim is in deep water and no buoyant rescue aid is available, has not been reported previously. The aim of this pilot study was to evaluate the feasibility and efficacy of in-water unsupported rescue breathing.

Section snippets

Setting and equipment

The study was conducted at the Munrow centre indoor swimming pool at the University of Birmingham, UK. A Laerdal adult resuscitation manikin was modified to incorporate a Schiller spirovit sp-1™ pneumotachograph. When immersed in water, the manikin had neutral buoyancy and similar towing characteristics to an adult male casualty. The pneumotachograph was set to tidal volume mode, which produced a graphical printout of inflation time and rescue breathing volume. Data were subsequently analysed

Results

The three lifeguards performed between seven and nine ventilations during each simulated rescue. This gave average inflation volumes for each lifeguard of 711 ml (S.D. 166), 750 ml (S.D. 108), 629 ml (S.D. 182) and average inflation duration of 0.8 s (S.D. 0.3), 0.9 s (S.D. 0.2) and 0.6 s (S.D. 0.1). The ventilation volumes and inflation duration for each breath are displayed in Fig. 2, Fig. 3. The rescue duration was increased from an average time of 1 min 10 s to 1 min 24 s by performing in-water

Discussion

This pilot study has demonstrated that in controlled conditions it was possible to perform unsupported rescue breathing whilst in water without greatly increasing the time taken to rescue a casualty. The ventilation volumes achieved were within the currently recommended range of 700–1000 ml for rescue breathing without supplemental oxygen. The inflation time of less than 1 s is, however, shorter than the 2 s duration recommended in current guidelines [9].

The importance of in-water resuscitation

Conclusion

This study has demonstrated the feasibility and potential efficacy of in-water unsupported rescue breathing with a victim in deep water. Furthermore, the technique did not unduly prolong rescue duration over a 50 m rescue. In circumstances, where the trained lifeguard finds themselves with an apnoeic victim in the water, with no buoyancy rescue aid available, they may consider the application of in-water, unsupported rescue breathing, especially if recovery to dry land is likely to be delayed.

Acknowledgements

I would like to thank Dr. RM Cayton and the Respiratory Physiology Service at Birmingham Heartlands Hospital for advice regarding study design and loan of the pneumotachograph used in this study.

Reference (17)

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    The rate of survival at hospital discharge was higher in the in-water resuscitation group (87.5% versus 25%; P<0.005), as was favorable neurological outcome (52.6% versus 7.4%; P<0.001).52 All other studies were crossover trials that evaluated the capacity of lifeguards53–56 and laypeople54 to perform in-water resuscitation while simulating a water rescue with a manikin. In-water resuscitation was technically difficult and physically demanding, particularly in open water.

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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at doi: 10.1016/j.resuscitation.2004.12.002.

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