Prehospital factors associated with ICU admission in drowning patients: a retrospective multicenter cohort study in a French coastal region

Despite its prevalence, limited data describe the European prehospital management of drowning victims outside cardiac arrest situations, and clinical decision-making remains heterogeneous across EMS systems. We aimed to describe the clinical characteristics, prehospital management, and outcomes of drowning patients, and to identify prehospital factors associated with intensive care unit (ICU) admission. We performed a retrospective multicenter study including all consecutive adult managed by the emergency medical service (EMS) call-center of the Var department (SAMU 83, France) with a “drowning” code between January 2019 and October 2022. Multivariate logistic regression analysis was used to identify prehospital factors associated with ICU admission. Among 296 included patients, 232 patients (78.3%) were admitted to hospital, including 130 (43.9%) to the ICU. Thirty-eight patients (12.8%) were discharge alive without admission, and 26 (8.8%) died during prehospital management. During hospital stay, 185/232 (79.7%) required respiratory support, including 51/185 (27.6%) with mechanical ventilation. Independent factors associated with ICU admission were initial impaired consciousness (OR = 4.4; 95%CI [1.3–15.3]; p = 0.02), Szpilman grade ≥ 3 (OR = 29.9; 95%CI [11.0–80.9]; p < 0.001), and immersion duration ≥ 1 min (OR = 9.0; 95%CI [2.5–32.2]; p < 0.001). Several prehospital clinical variables were associated with ICU admission in this retrospective cohort. These findings may inform EMS triage decisions, although prospective validation is required. The study was prospectively registered at Clinicaltrials.gov on 20 February 2023 (NCT05673486).