A systematic review of interventions for resuscitation following drowning.

Objectives: The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods: The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results: Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion: The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.

Variability of CPR training requirements among New Zealand health professionals.

AIM: To audit cardiopulmonary resuscitation (CPR) training and certification requirements of registered healthcare professionals in New Zealand. METHOD: An enquiry-based policy audit of all regulatory bodies under the Health Practitioners Competence Assurance Act 2003 (HPCA Act 2003), and vocational medical training and recertification providers accredited by the Medical Council of New Zealand (MCNZ). RESULTS: All the organisations approached (n=37) responded to the audit. Six of the 17 health professional regulatory bodies have some form of mandatory CPR certification requirement for initial registration, ongoing registration, or continuing professional development. The Midwifery Council, Dentistry Council, Podiatrists Board, and Pharmacy Council have the most comprehensive requirements. Twelve of the 20 vocational medical colleges specify some form of CPR training. The Royal New Zealand College of Urgent Care is the only one to require annual re-certification. CONCLUSION: This audit revealed a wide variety of CPR training and certification requirements across health professions in New Zealand. Future studies should investigate whether mandating CPR training improves outcomes from cardiac arrest and consider patient, public, and whanau expectations regarding the ongoing certification of healthcare professionals in resuscitation and emergency care.

Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey.

BACKGROUND: Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. METHODS: This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. RESULTS: 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants' knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. CONCLUSIONS: This study provides the first insight into New Zealand podiatrists' CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study's findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12620001144909 ).

Need for consistent beach lifeguard data collection: results from an international survey.

BACKGROUND: Lifeguards are integral to beach safety and collect data which is used for a variety of purposes, although guidelines and best practice have yet to be established. This study served to identify and characterise existing beach lifeguard service provider (BLSP) data collection procedures in order to identify the degree of uniformity and areas for improvement. METHODS: The 'International Beach Lifeguard Data Collection and Reporting' online survey was distributed via the International Drowning Researchers' Alliance to BLSP supervisors and managers. The survey included questions on beach conditions and lifeguard activity data collection practices, and respondent's opinions on their own BLSP's methods. RESULTS: Variability in data collection practices was evident in surveys obtained from 55 lifeguard leaders in 12 countries. Discrepancies exist in definitions for 'rescue' among BLSPs, a significant amount of information related to beach conditions are recorded and beach visitation is primarily obtained by visual estimate. Respondents expressed challenges with getting frontline staff to collect information in the field and ensuring reporting consistency between recorders. They identified rescue victim demographic factors as key data they would like to collect in the future. CONCLUSIONS: Inconsistencies in lifeguard data collection present challenges to operations, safety education and prevention efforts, research and policy relying on these data. Variation in definitions, methods and collected variables generally restricts analysis to a single BLSP with limited generalisability to other beach settings. Some gaps in lifeguard data collection may soon be addressed by technology, but developing uniform, internationally acceptable standards and definitions should be prioritised.

Fatal coastal drowning incidents: A 10-year review of body recovery times in New Zealand.

Despite drowning being a leading cause of unintentional injury worldwide, gaps in the data still exist. One area where limited data is available to guide lifeguards, police, search and rescue agencies, accident and forensic investigators, ocean scientists, and the coroner, is how far from the last known point (displacement) a missing person is likely to be found, and the time frame for this to occur. This lack of certainty can exacerbate the emotional toll on family, friends, and rescuers. This study aimed to describe body recovery times and displacement for fatal coastal drowning incidents in New Zealand. Using DrownBase™, the National Coronial Information System, and media reports, data were extracted for all fatal coastal-missing-person drowning incidents from 2008 to 2017. A total of 219 cases were selected. Almost all incidents involved males (92%) and minority groups (e.g., Maori and Pasifika) were over-represented. Older adults (> 42 years) were more likely to be engaged in boating, whereas for younger adults (≤ 42 years), it was swimming. Most missing persons were described as good swimmers (51%) and wearing everyday clothing (48%), yet only 4% wore a lifejacket. Most incidents were observed (63%), and rescue was attempted in 86% of cases. Most bodies (58%) were recovered within 24h, and only 15% were not found (9%) or not reported (6%). Most missing persons (64%) were either found in the same location (57%) or <1km from where they entered the water (7%). The quality of on-scene data limited some analysis, and the results of this study may not apply to all aquatic locations. Improved data collection could inform real-time predictive modelling of where and when a missing person might be found. The involvement of forensic and ocean scientists in future study design to widen applicability to these domains is also recommended. Fewer lives would be lost to drowning, however, if safer practices were adopted when recreating or working in, on, or around water.

Paediatric cardiopulmonary resuscitation: Knowledge and perceptions of surf lifeguards.

AIM: To conduct a comprehensive analysis of surf lifeguards' real and perceived ability in paediatric cardiopulmonary resuscitation (CPR), knowledge of child resuscitation protocols and technical competency during a simulated CPR scenario. METHODS: Surf lifeguards aged 16 years and over were invited to complete a written survey and simulated test of five cycles of single-rescuer CPR on a paediatric manikin. In accordance with the latest Australia and New Zealand Committee on Resuscitation (ANZCOR) guidelines, practical skills were assessed by trained observers. A manikin fitted with electronic data-collection capability recorded technical compression and ventilation skills. RESULTS: A total of 244 participants were entered into the study. Most previous CPR training did not include a paediatric component (53%). Lifeguards rated their ability to perform CPR on an adult as 'highly effective' or 'effective' in 56% of responses. Less than a quarter (23%), however, gave this response when compared to a child. Observed CPR skills were mostly compliant with ANZCOR guidelines (80-99%). Manikin data provided a median compression rate of 115.6 min-1 , compression depth of 3.7 cm and tidal volume of 220.0 mL. Almost half of ventilations were too little (45%), and around one fifth were too much (22%). CONCLUSIONS: Surf lifeguards are less confident in paediatric CPR. The overall performance of observed and technical CPR skills, which were mostly ANZCOR guideline compliant, suggests that performance could be improved if paediatric-specific training is provided to supplement the adult-focused methods currently in use. The use of electronic feedback manikins is recommended to address the technical compression and ventilation issues identified in this study.

'Dry drowning' and other myths.

Drowning is a common and often preventable cause of death, especially in children. The mass media often propagate misinformation about "dry" and "secondary" drowning, diverting attention from appropriate efforts to prevent drowning and rescue and treat those who do drown.

Is drowning a mere matter of resuscitation?

International data severely underestimates actual drowning numbers. Almost all victims are able to help themselves or are rescued in time. This study aims to report the occurrence of Drowning Chain of Survival actions and resuscitations needed in a fully operational lifeguard service. METHODOLOGY: Data was collected from Dec-2009 to Mar-2015 by lifeguards at a 6km-long beach in Brazil. The Drowning Chain of Survival links were summarized into 3 main action-response sections: Prevention; rescue; and provide care. Rescues were classified by severity. RESULTS: Lifeguards reported 1,565,699 actions during the study period. Preventative actions comprised 1,563,300(99.8%) and 2044 (0.1%) involved recognizing a person in stress/distress and rescuing them. Of those requiring rescue, 355(0.02%) needed medical assistance due to respiratory symptoms, isolated respiratory arrest, or cardiopulmonary arrest. Those cases were classified by severity as: Grade 1 = 234(65.9%), grade 2 = 78(22%), grade 3 = 22(6.2%), grade 4 = 7(2%), grade 5 = 4(1.1%), and Grade 6 = 10(2.8%). From all 2044 rescues, 14(0.7%) were grade 5 and 6 and needed respiratory or cardiorespiratory resuscitation. An estimative incident rate for each day at a lifeguarded beach revealed: 1 rescue for every 4.227 beach attendances, 1 drowning for every 24,338 beach attendances, and 1 instance of CPR being performed for every 617,142 beach attendances. The prevalent misconception that majority of drowning require resuscitation is perpetuated by the media and publishers. We are only just seeing the tip of the iceberg and urgently need to look at the problem in its entirety. Considering all the intervention undertaken by lifeguards in a fully operational system, the incidence of resuscitation being performed is only one in every 112,000 lifeguarding actions (0.0009%).

Comment on Cerland, L. et al. Incidence and Consequences of Near-Drowning-Related Pneumonia-A Descriptive Series from Martinique, French West Indies. Int. J. Environ. Res. Public Health 2017, 14, 1402.

We read with great interest the recent paper by Cerland et al. on the frequency, nature, and consequences of post-drowning pneumonia[...].

2015 Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation: An ILCOR Advisory Statement.

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.

2015 revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement.

BACKGROUND: Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning. METHODS: An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details. RESULTS: The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture. CONCLUSIONS: The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.

The 4Rs of Aquatic Rescue: educating the public about safety and risks of bystander rescue.

From 1980 to 2014, 87 persons drowned in New Zealand while attempting to rescue others; all incidents occurred in open water and most (80%) fatalities were male. While bystander rescue has been promoted as a way of preventing drowning, little is known about the knowledge base that informs potential rescuers. This study utilized a family water safety programme to promote a resource entitled the 4Rs of Aquatic Rescue. Participants (n = 174) completed a pre-intervention survey and were then provided with information and access to electronic resources on safe bystander rescue techniques. Most respondents (71%) had never been taught rescue techniques, and males were more confident of their rescue ability. Upon completion of the programme, significant differences were evident in respondents' understanding of rescue safety, but this did not translate to greater confidence or disposition towards performing a rescue. Ways of promoting bystander safety around water are discussed and recommendations for future studies are made.