Outcomes of Pediatric Drowning in the Pediatric Intensive Care Unit

Objective: Drowning remains a leading cause of death in children. Knowledge of outcomes of these patients who survive drowning but require critical care is lacking. We aim to study the current mortality rate, describe interventions and associated diagnoses, and examine factors related to risk of death in drowning victims admitted to the pediatric intensive care unit (PICU). Methods: Retrospective multicenter cohort study utilizing data from the Virtual Pediatric Systems Database in 143 PICUs between January 1, 2010 and December 31, 2019. Patients between 0-18 years old admitted to a PICU with a diagnosis of drowning were included. The primary outcome was death prior to hospital discharge. Predictors included demographics, critical care interventions, and associated diagnoses. Odds ratios were calculated using multivariate logistic regression. Results: There were 4,855 patients admitted with drowning across the study period. The overall PICU mortality rate in this cohort was 18.7%. Factors associated with an increased odds of death included being transported from an outside hospital, mechanical ventilation, central line placement, cardiac arrest, respiratory failure, and hypoxic ischemic encephalopathy. In 2,479 patients requiring mechanical ventilation, 63 were treated with ECMO which was not associated with mortality. Conclusions: This data provides updated insight into pediatric drowning victims requiring critical care, and their prognosis as it relates to the interventions they receive. Overall PICU mortality rates for drowning are higher than overall PICU mortality and mortality from other causes of injury. These findings have implications for the care of drowned children in ICU environments and in continued preventive efforts.