Characteristics of pediatric drowning out-of-hospital cardiac arrests in the United States.

AIMS: Drowning is a leading cause of pediatric death in the United States, yet data characterizing these arrests is limited. Our study aimed to describe demographic and emergency medical services (EMS) response characteristics for drowning-related pediatric out-of-hospital cardiac arrests (pOHCAs).

METHODS

Using the 2023 National Emergency Medical Services Information System dataset, we conducted a cross-sectional study of EMS-attended 9-1-1 responses involving children 1 day-17 years old who experienced a drowning-related pOHCA. We used descriptive statistics and multivariable logistic regression (adjusted odds ratio; 95% confidence intervals) to identify factors associated with return of spontaneous circulation (ROSC).

RESULTS

Our study included 753 drowning-related pOHCAs. Most arrests were toddlers aged 1-4 years (57.8%), males (64.5%), at private residences (72.5%), and in urban settings (83.7%). EMS clinicians were commonly dispatched during the summer (46.7%) and between 12:00 and 17:59 (47.4%). Arrests were often unwitnessed (73.7%) and received bystander cardiopulmonary resuscitation (CPR) (81.3%). Fifty-four percent of adolescent arrests were unwitnessed compared to 80.5% among toddlers (P < 0.001). Most arrests (81.3%) received bystander CPR. Shockable rhythms were uncommon (4.6%). EMS-witnessed ROSC was obtained in 42.0% of arrests. In multivariable regression, adolescent age (3.25; 1.25-8.79), witnessed arrests (1.59; 1.03-2.45), and bystander CPR (2.83; 1.67-4.96) were associated with higher odds of ROSC.

CONCLUSIONS

Most drowning-related pOHCAs involved young children, with age-based differences in scene characteristics and pre-EMS arrival factors. Adolescent arrests were more frequently witnessed and more likely to obtain ROSC. Opportunities exist to improve drowning prevention among children and enhance the chain of survival.