Synopsis
Recognise drowning as a hypoxic emergency, deliver ventilation-led resuscitation safely, prevent further heat loss, use temperature-specific arrest modifications and coordinate critical care, safeguarding and follow-up after return of circulation.
- Drowning is respiratory impairment from submersion or immersion; use non-fatal or fatal drowning, not dry, wet or near drowning.
- Rescuer safety comes first: use flotation or reach-and-throw methods and enter water only if trained.
- First-line resuscitation begins with five rescue breaths, ideally with 100% oxygen, followed by paediatric CPR if there are no signs of life.
- Do not perform abdominal thrusts or try to drain lung water; this delays ventilation and increases aspiration risk.
- Attach an AED after the chest is dried, but do not interrupt oxygenation and CPR to do so.
- Assume cervical injury only when the mechanism suggests trauma; routine immobilisation delays airway care.
- Remove wet clothing, dry, insulate and warm the trunk; avoid rubbing or warming limbs aggressively.
- Measure core temperature with a low-reading device and continue resuscitation unless an expert determines futility.
- Below 30 degrees Celsius in arrest, give a maximum of three shocks and withhold further shocks and adrenaline until temperature exceeds 30; seek expert extracorporeal rewarming.
- At 30 to 35 degrees Celsius, extend adrenaline intervals to about 6 to 10 minutes, commonly every 8 minutes, until normothermia.
- After return of circulation, target SpO2 94 to 98%, normocapnia, normoglycaemia and controlled rewarming while avoiding fever.
- Investigate the reason for immersion, document supervision and development, and address water safety before discharge.
Key red flags
Apnoea, gasping, absent signs of life or a heart rate below 60/min with poor perfusion despite effective oxygenation and ventilation requires immediate paediatric resuscitation.
Persistent hypoxaemia, severe work of breathing, frothy secretions, crackles or exhaustion after submersion suggests evolving lung injury and needs early ventilatory escalation.
Core temperature below 35 degrees Celsius, reduced consciousness, bradycardia or ventricular arrhythmia indicates clinically important hypothermia; handle gently and use a low-reading core thermometer.
A temperature below 30 degrees Celsius with cardiac arrest changes adrenaline and defibrillation timing and should prompt direct expert discussion about extracorporeal rewarming.
Trauma, intoxication, seizure, hypoglycaemia, arrhythmia or maltreatment may have preceded immersion and must not be obscured by the drowning diagnosis.
Unexplained immersion, supervision inconsistent with development, delayed presentation or associated injuries requires immediate safeguarding review.
Investigation priorities
Quantify oxygenation, detect arrhythmia and guide temperature-specific resuscitation.
Assess ventilation, acidosis, glucose and metabolic consequences of hypoxia or cold.
Management branches
A child is removed from water and is unresponsive or not breathing normally.
- Call emergency help and open the airway.
- Give five effective rescue breaths, with oxygen if available.
- Start paediatric CPR and attach an AED while minimising interruptions.
- Continue ventilation-focused resuscitation and prevent further cooling during transfer.