• Brent D Bauman, Amanda Louiselle, Rachel M Nygaard, Victor Vakayil, Robert Acton, Donavan Hess, Daniel Saltzman, Nathaniel Kreykes, Gwenyth Fischer, Jeffrey Louie, and Bradley Segura.
• From the Department of Surgery, University of Minnesota.
• Pediatr Emerg Care. 2021 Oct 1; 37 (10): e653e659e653-e659.

ObjectivesDrowning is the second leading cause of death in children. Extracorporeal membrane oxygenation (ECMO) has become the criterion standard therapy to resuscitate the hypothermic drowning victim in cardiac arrest. We present our own experience treating 5 children with hypothermic cardiac arrest in conjunction with a systematic review to analyze clinical features predictive of survival.MethodsOur search resulted in 55 articles. Inclusion criteria were as follows: (1) younger than 18 years, (2) ECMO therapy, and (3) drowning. Ten articles met our inclusion criteria. We included studies using both central and peripheral ECMO and salt or fresh water submersions. We compared clinical features of survivors to nonsurvivors.ResultsA total of 29 patients from the 10 different studies met our criteria. Data analyzed included presenting cardiac rhythm, time to initiation of ECMO, submersion time, pH, potassium, lactate, duration of chest compressions, and survival. There was a significant increase in mortality for presenting rhythm of asystole and with hyperkalemia (P < 0.05).ConclusionsExtracorporeal membrane oxygenation is an important resuscitation tool for the hypothermic drowning victim. Hyperkalemia and presenting cardiac rhythm correlate with survival although they are not reasons to end resuscitation. More studies are needed to compare the outcomes in using ECMO for the hypothermic drowning victim.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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