Severe autonomic dysfunction in a child with accidental drowning: is it a predictor for survival?

Drowning is the third most common cause of accidental death in children. Various predictors for survival and neurological dysfunction include the age of victim, submersion time, salt versus fresh water, temperature of water, cardiopulmonary resuscitation at the scene, and time required to hospital arrival. Autonomic dysfunction, in particular heart rate variability in a critically ill patient, has been attributed to good neurological outcomes. We hereby describe a 10-year-old boy who accidentally drowned and developed a substantial heart rate variability with autonomic dysfunction. He was in the need for prolonged vasopressor support but eventually had a good neurological outcome.