Pediatric Drowning/Submersion
Child pulled from water - unresponsive
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PediatricsEmergency
Pediatric Drowning Resuscitation (AHA 2024-2025)
Pediatric Drowning Resuscitation (AHA 2024-2025): Pediatric Drowning/Submersion → Remove from Water Safely → Responsive or Breathing? → Responsive/Breat...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Remove from Water Safely
Water rescue + initial assessment
- Remove victim from water as quickly as possible
- Maintain horizontal position during removal if possible
- Assume C-spine injury if mechanism suggests (diving, fall)
- In-water resuscitation:
- • Trained rescuers may begin rescue breaths in water
- • Chest compressions not effective in water
03Decision Responsive or Breathing?
Quick assessment on land
04Action Responsive/Breathing
Recovery position and monitor
- Place in recovery position
- Remove wet clothing, prevent hypothermia
- Administer O2 if available
- Monitor for deterioration
- Transport to ED even if appears well
- (risk of delayed pulmonary edema)
05Action Unresponsive - Start CPR
Prioritize ventilation
- DROWNING = HYPOXIC ARREST
- Ventilation is critical!
- LAY RESCUERS: Begin CPR (may start with compressions)
- TRAINED RESCUERS:
- • Consider starting with rescue breaths (A-B-C)
- • Or compressions first (C-A-B) - both acceptable
- • 5 rescue breaths initially reasonable
- Compression:ventilation = 30:2 (single) or 15:2 (two rescuers)
06Action Apply AED/Monitor
Assess rhythm when available
- Dry chest before applying pads
- Shockable rhythm (VF/pVT) less common in drowning
- If VF/pVT: Defibrillate per PALS
- If asystole/PEA: Continue CPR, epinephrine
- Drowning cardiac arrest usually asystole/PEA (hypoxic)
07Action PALS Protocol
Standard pediatric resuscitation
- Continue high-quality CPR
- Epinephrine 0.01 mg/kg IV/IO q3-5 min
- Advanced airway when appropriate
- O2 100% during resuscitation
- Address hypothermia:
- • Remove wet clothing
- • Warm blankets, warm IV fluids
- • Do not delay resuscitation for rewarming
08Decision ROSC?
Return of spontaneous circulation
09Outcome Post-Drowning Care
ROSC achieved
- Maintain SpO2 94-99% (avoid hyperoxia)
- Avoid hyperventilation
- Treat hypothermia (target normothermia)
- Consider targeted temperature management
- Monitor for:
- • Pulmonary edema (CXR)
- • Aspiration pneumonia
- • ARDS
- • Electrolyte abnormalities
- ICU admission for all drowning arrests
10Warning Prognostication
When to consider stopping
- POOR PROGNOSTIC FACTORS:
- • Submersion >25 minutes
- • Resuscitation >25 minutes without ROSC
- • Asystole as presenting rhythm
- • No pupillary response
- • No bystander CPR
- Cold water submersion may have better outcomes
- Consult team before termination
- No absolute cutoff - individualize decision
- Path rejoins step 07Shared downstream outcome
Guideline Source
AHA/AAP 2024 Focused Update: Resuscitation Following Drowning
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not address cervical spine injury
- Submersion time key prognostic factor
- Post-arrest care based on general PALS guidelines
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Drowning Resuscitation (AHA 2024-2025)?
The Pediatric Drowning Resuscitation (AHA 2024-2025) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on AHA/AAP 2024 Focused Update: Resuscitation Following Drowning.
What guideline is the Pediatric Drowning Resuscitation (AHA 2024-2025) based on?
This algorithm is based on AHA/AAP 2024 Focused Update: Resuscitation Following Drowning (DOI: 10.1161/CIR.0000000000001274).
What are the limitations of the Pediatric Drowning Resuscitation (AHA 2024-2025)?
Known limitations include: Does not address cervical spine injury; Submersion time key prognostic factor; Post-arrest care based on general PALS guidelines. Individual patient factors may require deviation from these recommendations.
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