Pediatr Emerg Med J.  2025 Apr;12(2):73-77. 10.22470/pemj.2024.01158.

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

• Nanda S
• Agarwal S
• H.S A
• Kaul S
• Nimesh M
• Patra B

• KMID: 2567074
• DOI: http://doi.org/10.22470/pemj.2024.01158

Abstract

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.

Keyword

Autonomic Dysreflexia; Autonomic Nervous System Diseases; Child; Drowning; Treatment Outcome

Figure

• 

  Fig. 1. The initial chest radiograph showing a bat wing appearance suggestive of severe pulmonary edema.

• 

  Fig. 2. Electrocardiograms on days 2-3, showing sinus bradycardia (A), sinus tachycardia (B), and normal sinus rhythm (C).

Reference

References

1. Pellegrino F, Raffaldi I, Rossi R, De Vito B, Pagano M, Garelli D, Bondone C. Epidemiology, clinical aspects, and management of pediatric drowning. Ital J Pediatr. 2023; 49:74.

2. Quan L, Bierens JJ, Lis R, Rowhani-Rahbar A, Morley P, Perkins GD. Predicting outcome of drowning at the scene: A systematic review and meta-analyses. Resuscitation. 2016; 104:63–75.

3. Shattock MJ, Tipton MJ. ‘Autonomic conflict’: a different way to die during cold water immersion? J Physiol. 2012; 590:3219–30.

4. Barwood MJ, Eglin C, Hills SP, Johnston N, Massey H, McMorris T, et al. Habituation of the cold shock response: a systematic review and meta-analysis. J Therm Biol. 2024; 119:103775.

5. Abelairas-Gómez C, Tipton MJ, González-Salvado V, Bierens JJ. Drowning: epidemiology, prevention, pathophysiology, resuscitation, and hospital treatment. Emergencias. 2019; 31:270–80.

6. Grmec S, Strnad M, Podgorsek D. Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med. 2009; 2:7–12.

7. Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, et al. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol. 1985; 248(1 Pt 2):H151–3.

8. Chegondi M, Sasaki J, Naqvi S, Lin WC, Raszynski A, Totapally BR. Heart rate variability in children following drowning injury. Indian J Crit Care Med. 2018; 22:53–5.

9. Goldstein B, Fiser DH, Kelly MM, Mickelsen D, Ruttimann U, Pollack MM, et al. Decomplexification in critical illness and injury: Relationship between heart rate variability, severity of illness, and outcome. Crit Care Med. 1998; 26:352–7.

10. Biswas AK, Scott WA, Sommerauer JF, Luckett PM. Heart rate variability after acute traumatic brain injury in children. Crit Care Med. 2000; 28:3907–12.