CPR for Near-Drowning: Essential Steps and Guidelines

Near-drowning incidents are critical emergencies where timely and effective CPR means the difference between life and death. Increasing the chance of survival requires an understanding of the aspects involved in administering CPR to a person who is about to drown. This guide will bring you through the particular steps for performing CPR in the event of a near-drowning, taking into account any emergencies involving water.

What is Near Drowning?

Near drowning occurs when a person has suffered from submersion in water but has not died from the incident. It is often accompanied by severe respiratory distress, making immediate intervention essential. It occurs when a person experiences impairment from submersion, leading to severe respiratory distress, therefore getting help right away is crucial to avoiding further issues. The risk of drowning is significant, and near drowning is a crucial stage before it becomes life-threatening, which, if untreated, leads to severe respiratory impairment and even fatal outcomes.

The Impact of Water Submersion?

Water submersion impacts the body significantly, primarily affecting the lungs and brain. Pulmonary edema and respiratory discomfort result from water entering the lungs, though in some cases, known as 'Dry Drowning,' water does not enter the lungs. The brain suffers from a lack of oxygen during submersion, which leads to impairment. However, recent research suggests that even prolonged submersion might not cause irreversible damage if swift resuscitation is provided.

Immediate action, such as CPR, is crucial to restore oxygen flow, prevent cardiac arrest, and address any potential complications, highlighting the importance of understanding the body's defenses against drowning.

Why CPR is Critical for Near Drowning Victims?

CPR is critical for near-drowning victims because it helps restore oxygen flow to the brain and vital organs, preventing permanent damage and increasing the chances of survival. When a person is submerged in water, their lungs fill with fluid, leading to asphyxiation and cardiac arrest. Immediate CPR helps maintain circulation and oxygenation until professional medical help arrives. Without prompt intervention, the lack of oxygen causes irreversible brain damage within minutes, making CPR a vital life-saving technique in near-drowning situations.

Is CPR performed differently for victims of drowning?

Yes. CPRW is performed differently for victims of drowning. When performing CPR on drowning victims, starting with two rescue breaths before chest compressions is crucial, as they often suffer from oxygen deprivation due to water inhalation.

According to the American Heart Association (AHA), the breaths may be given mouth-to-nose if still in the water. Studies, such as 10-year Australian research, show that 86% of drowning victims vomit during CPR, requiring their airways to be cleared by turning them to the side. Laryngospasm often limits water entry into the lungs, making airway clearing less critical.

Differences from Conventional CPR

Near-drowning CPR differs from conventional CPR due to factors related to water immersion:

• Water in the Lungs: Water in the lungs affects chest compressions and rescue breaths, especially if it's freshwater, which dilutes electrolytes and causes complications like ventricular fibrillation. This hinders the lungs from expanding fully, reducing air intake and making it harder to oxygenate the blood effectively.
• Hypothermia: Common in near-drowning victims, hypothermia lowers heart rate and circulation, complicating pulse assessment and chest compressions. It reduces the body’s oxygen demand and slows metabolism, impacting the effectiveness of resuscitation and defibrillation. Rewarming must be done carefully to avoid abrupt blood pressure drops and other issues.

Supplemental oxygen is often needed alongside CPR to enhance oxygenation and prevent brain damage. Understanding Basic Life Support principles is crucial for addressing these specific challenges in near-drowning situations.

How to Perform CPR for Drowning Victims?

Here’s a quick guide on performing CPR for drowning victims:

1. Get help: Call 911 immediately or alert a lifeguard.
2. Move the person: Remove them from the water.
3. Check consciousness: If unresponsive, place them on their back.
4. Open the airway and deliver 2 rescue breaths: Tilt their head back, pinch their nose, and give two breaths while watching the chest rise.
5. Begin chest compressions: If the person isn’t breathing, start compressions at a rate of 100-120 per minute, pressing at least 2 inches deep for adults. Alternate 30 compressions with 2 breaths.
6. Continue CPR: Keep performing CPR until the person breathes or emergency help arrives.

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1. Call for Help

Immediately call 911 or ask someone else to do so. Time is critical in near-drowning incidents, so getting professional help on the way should be your priority. If a lifeguard is available, alert them as they are trained to handle water emergencies. If you’re alone and need to call 911, put the phone on speaker to keep your hands free for CPR.

2. Safely Remove the Person from the Water

Before attempting to rescue the person, make sure you won’t be in danger of drowning yourself. If the person is close enough to grab or if there is rescue equipment (such as a lifebuoy or a stick), use those to pull them to safety.

When you get the person out of the water, be careful not to jostle them too much. If they have suffered a neck or spinal injury, unnecessary movement could cause further harm.

3. Check for Responsiveness and Breathing

Once the person is on dry land, check if they are conscious by tapping them on the shoulder and shouting. Look for any movement or response. Simultaneously, observe if they are breathing. Look for chest movement, listen for breath sounds, and feel for air coming from their mouth or nose.

A near-drowning victim needs CPR if they are:

• Unconscious
• Not breathing or only gasping
• Lack of a detectable pulse
• Exhibit cyanosis (bluish or pale skin)

These signs indicate severe respiratory arrest or cardiac distress, and immediate CPR is essential to restore normal breathing and circulation.

3. Open the Airway

Place one hand on their forehead and the other under their chin. Gently tilt their head back while lifting the chin upward. This helps to prevent the tongue from blocking the airway. Ensure the airway is clear. Check again for any signs of breathing.

4. Give Rescue Breaths

Properly open the victim’s airway to ensure it’s clear for breathing:

• Pinch and Seal: Pinch the person’s nose shut and create a seal over their mouth with your own. Breathe steadily into their mouth for about 1 second, watching to see if the chest rises. If it rises, the breath has gone in; if not, reposition the head (tilt the head further back) and try again.
• Two Breaths: If the chest rises with the first breath, give a second breath. Each breath should be slow and controlled, lasting about 1 second.
• If the Chest Doesn’t Rise: If, after tilting the head again, the chest still doesn’t rise, it could indicate that the airway is blocked. Continue chest compressions, but keep trying to provide breaths after each round of compressions.

Hands-only CPR is not recommended for drowning victims. Unlike sudden cardiac arrest, drowning primarily causes respiratory failure, so oxygen is crucial.

5. Perform Chest Compressions

• Positioning: Place the victim on their back on a firm surface. Kneel beside them, positioning yourself at their chest level.
• Hand Placement: Place the heel of one hand on the center of the chest (right between the nipples). Place your other hand on top of the first, interlocking your fingers.
• Compression Technique: Use your upper body weight to press down hard and fast. Compress the chest at least 2 inches deep (for adults) at a rate of 100 to 120 compressions per minute. Allow the chest to rise fully between each compression but keep the rhythm consistent.
• Count Aloud: Perform 30 chest compressions in quick succession. It helps to count out loud to keep track.

6. Continue the Cycle: 30 Compressions and 2 Breaths

Repeat cycles of chest compressions and rescue breaths. If you’re alone, continue this sequence until the person starts to breathe on their own or until emergency services arrive.

• Don’t Stop Until Help Arrives: Performing CPR is exhausting, but it’s crucial not to stop until medical professionals take over or the person regains consciousness.
• Post-Drowning Care: Even if the person starts breathing again, they should still go to the hospital. Drowning causes damage to the lungs and other internal organs, and complications like "secondary drowning" occur hours later.

By following these steps, you maximize the chances of survival in a near-drowning emergency.

Monitoring the Person’s Condition

Keep checking if the person starts breathing on their own. If they begin to breathe, place them in the recovery position (lying on their side) and continue to monitor them. They still require medical attention, even if they seem to have recovered.

Once the victim starts breathing again but is still unconscious, position the victim on their side in the recovery position to keep the airway open and prevent choking if they vomit. Continuously monitor their breathing and pulse, and be prepared to resume CPR if they stop breathing.

If the victim regains consciousness: Cover with a blanket to maintain body warmth and prevent hypothermia, but avoid overheating. Proper cardiovascular care is vital during the recovery phase to ensure stabilization, and the victim should be transferred to a hospital for further critical care. Keep them calm and still, as sudden movements could worsen their condition.

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Additional Considerations for Children and Babies:

• Children’s CPR: For children, use one hand instead of two for chest compressions, and compress the chest to a depth of about 2 inches.
• Infant CPR: For babies under 1 year old, use two fingers to compress the chest, pressing down about 1.5 inches deep. Use gentler breaths—cover both the mouth and nose of the baby with your mouth and deliver puffs of air rather than full breaths.
• Compression to Breath Ratio: For both children and infants, give 30 compressions followed by 2 gentle breaths. If two rescuers are present, switch to 15 compressions for every 2 breaths.

Special Considerations: Consider the chance of spinal injuries when giving CPR to people who are on the verge of drowning, especially if the incident involved shallow water or a large impact. While doing CPR, keep the head and neck stable to avoid injury.

Keep in mind that the person has consumed a lot of water, which increases the likelihood of vomiting. Before starting CPR again, swiftly move the victim's head to the side to clear their airway if they start vomiting. Finally, remember that prolonged submersion leads to complications like pulmonary edema, so continue to monitor the victim’s condition and be prepared to adapt your approach as needed.

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Current Guidelines and Recommendations

The American Heart Association (AHA) advises that in near-drowning cases, immediate attention should be given to oxygenation, ventilation, and restoring perfusion, emphasizing the importance of prompt bystander CPR and activation of emergency medical services (EMS). They recommend transporting all resuscitated drowning victims to a hospital for further evaluation by a healthcare provider, regardless of their apparent condition.

The World Health Organization (WHO) supports the Utstein style and definition of drowning, which ensures consistent data reporting and highlights that drowning primarily involves respiratory failure due to submersion in a liquid. Additionally, the European Resuscitation Council (ERC) recommends administering five initial rescue breaths to overcome airway obstruction caused by water, which improves neurological outcomes by ensuring better oxygenation before starting chest compressions.

Why Regular Training is Essential

Regularly updated training helps individuals maintain readiness for specific scenarios like near-drowning, where quick and effective intervention makes a critical difference. Knowing the nuances of water-related CPR, such as the importance of initial rescue breaths, significantly improves outcomes.

It's important to ensure that any training for near-drowning CPR is provided by certified organizations and not ineligible companies that lack proper accreditation.

What are the signs that CPR is working?

Signs that CPR is working include the person starting to gasp or breathe on their own (which includes shortness of breath as their body begins to recover), visible chest rise with each rescue breath, an evident pulse indicating the heart is pumping blood, improved skin color as oxygenated blood circulates, and signs of consciousness such as opening eyes or responding to verbal cues. These indicators suggest that CPR is effective and the person’s condition is improving.

What are the success rates of CPR in near-drowning cases?

The success rates of CPR in near-drowning cases vary widely based on several factors, including the duration of submersion, water temperature, and the speed of intervention. When the victim is given fast access to advanced medical care and is given adequate resuscitation, there is an increased chance of a positive outcome. Immediate action reduces the risk of accidental death.

How should CPR be modified if the near-drowning victim is a child or infant?

When conducting cardiopulmonary resuscitation (CPR) on a child or newborn who has almost drowned, use two fingers for chest compressions in infants, pressing about 1.5 inches deep at a rate of 100-120 per minute, and one or two hands for children, compressing about 2 inches deep at the same rate.

For infants, use mouth-to-nose or mouth-to-mouth for gentle breaths, ensuring each breath lasts one second and makes the chest rise visibly. For children, use the mouth-to-mouth technique. If two rescuers are present, alternate between 30 compressions and 2 breaths, or 15 compressions and 2 breaths. Keep the head in a neutral position to maintain an open airway.

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How does CPR certification prepare you for near-drowning situations?

CPR certification thoroughly prepares you for near-drowning situations by teaching the specific protocols needed to effectively respond. In a near-drowning scenario, the victim often experiences respiratory distress or arrest due to water inhalation. CPR certification trains you to immediately assess the victim's condition, perform rescue breaths to re-oxygenate the body, and administer chest compressions to maintain circulation. The training emphasizes the importance of rapid response and teaches techniques tailored for water-related incidents, such as delivering rescue breaths first and understanding the potential for complications like vomiting during compressions. This comprehensive knowledge ensures you are ready to act confidently and effectively in near-drowning emergencies.

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Sources:

• Healthdirect Australia. (n.d.). How to perform CPR. On Adults, Children and Babies | Healthdirect. https://www.healthdirect.gov.au/how-to-perform-cpr#:~:text=Keep%20going%20with%20repeated%20cycles,arrives%20and%20takes%20over%20CPR
• Hoeft, M. (2023, May 8). Emergency Preparation By Using Drowning CPR with Rescue Breaths. NDPA. https://ndpa.org/emergency-preparation-drowning-cpr/#:~:text=Performing%20CPR%20with%20rescue%20breaths,eventual%20respiratory%20and%20cardiac%20arrest.
• Hypothermia: First aid. (2024, April 16). Mayo Clinic. https://www.mayoclinic.org/first-aid/first-aid-hypothermia/basics/art-20056624
• Moore, K. (2018, September 29). Near-Drowning. Healthline. https://www.healthline.com/health/near-drowning#:~:text=What%20is%20near%2Ddrowning%3F,to%20prevent%20related%20health%20complications.
• Part 10.3: Drowning. (2005). Circulation, 112(24_supplement). https://doi.org/10.1161/circulationaha.105.166565
• Pellegrino, F., Raffaldi, I., Rossi, R., De Vito, B., Pagano, M., Garelli, D., & Bondone, C. (2023). Epidemiology, clinical aspects, and management of pediatric drowning. Italian Journal of Pediatrics, 49(1). https://doi.org/10.1186/s13052-023-01464-1
• Quan, L., Mack, C. D., & Schiff, M. A. (2014). Association of water temperature and submersion duration and drowning outcome. Resuscitation, 85(6), 790–794. https://doi.org/10.1016/j.resuscitation.2014.02.024
• The Editors of Encyclopaedia Britannica. (2024, August 5). Drowning | Symptoms, causes & treatment. Encyclopedia Britannica. https://www.britannica.com/science/drowning

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