Recent updates from prominent health organizations emphasize the importance of administering CPR, complete with rescue breaths and chest compressions, to individuals who have experienced drowning. The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) released new guidelines that underscore these life-saving techniques. These recommendations were unveiled on Tuesday in the medical journals Circulation and Pediatrics. The Pediatrics article particularly highlights the evolving resuscitation strategies for children, while the piece in Circulation discusses both adult and pediatric resuscitation following drowning incidents.

The updated guidelines introduce the concept of the “drowning chain of survival,” which outlines key steps in handling drowning situations. This includes prevention strategies, recognizing signs of distress in individuals, the importance of utilizing flotation devices, safely extracting individuals from the water, and providing effective care following such incidents. Dr. Tracy E. McCallin, co-chair of the writing group, noted that this revised guidance offers healthcare professionals, trained rescuers, caregivers, and families the latest evidence-based insights on resuscitating drowning victims.

Drowning remains a critical global issue, ranking as the third leading cause of accidental deaths, claiming approximately 236,000 lives annually, as reported by the World Health Organization. In the United States, it is especially perilous for children aged 1 to 4, as indicated by the Centers for Disease Control and Prevention (CDC). Most drownings among infants occur in bathtubs, while school-aged children are more likely to drown in pools. The statistics are particularly concerning among Black, American Indian, and Alaska Native youth, underscoring an urgent need for improved access to swimming education and preventive measures. The AHA and AAP strongly advocate for increased awareness of water safety.

The new guidelines delve into aspects previously overlooked by the AHA, emphasizing actions like providing rescue breaths while still in the water, administering oxygen after a drowning incident, using automated external defibrillators (AEDs) in cases of cardiac arrest due to drowning, and encouraging public access to defibrillation programs. The updated best practices state that anyone surfacing from the water without normal breathing or consciousness should be immediately assumed to be in cardiac arrest. Rescuers are urged to start CPR right away, beginning with two rescue breaths, followed by 30 chest compressions. If a rescuer cannot or chooses not to administer rescue breaths, performing chest compressions alone is still a viable option until professional help arrives.

Evidence suggests that individuals who experience cardiac arrest from causes other than heart issues, such as drowning, have higher survival rates when CPR includes rescue breaths rather than relying solely on compressions. The guidelines stipulate that in-water rescue breathing should only be executed by trained individuals who can ensure their own safety. Additionally, trained rescuers should provide supplemental oxygen whenever it is available.

Drowning situations can escalate rapidly from respiratory arrest, where breathing ceases, to cardiac arrest, when the heart stops circulating blood, depriving the body of oxygen. Dr. Cameron Dezfulian, co-chair of the writing committee, emphasized the importance of focusing on restoring both breathing and blood circulation in CPR protocols for drowning-related cardiac events. Notably, cardiac arrests due to drowning are frequently a result of severe hypoxia, which differs from other sudden cardiac events characterized by an immediate collapse with oxygen-rich blood. According to the revised recommendations, AEDs can be utilized once the victim has been removed from the water, but CPR should commence beforehand. Dr. Dezfulian concluded that the goal of these guidelines is to harmonize the urgency of rescue efforts while ensuring the safety of the rescuer.