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An estimated 200,000 cardiac arrests occur out-of-hospital annually in the United States.1,2 The survival rates are 0–11% depending on the presenting rhythm.3,4 Following cardiac arrest, the brain can tolerate anoxia up to 2–4 minutes, upon which irreversible neuronal damage commences in the absence of re-establishment of circulation.5 Brain re-oxygenation with successful return of spontaneous circulation (ROSC) begins a deleterious chemical cascade that generates free radicals and other inflammatory mediators leading to devastating neurological outcomes termed post-resuscitation syndrome.6 The harmful effects of reperfusion injury can be mitigated with the use of therapeutic hypothermia (TH) as demonstrated in case reports and dog models from as early as the 1950s.7,8  Physiological benefits of post-resuscitation therapeutic hypothermia include reduction in cerebral metabolic demands, reduction in intracranial pressure, and attenuation of an array of temperature dependent deleterious biochemical processes.9 Therapeutic hypothermia may be neuroprotective in many causes of brain injury. There have been limited published data using therapeutic hypothermia to treat patients resuscitated from cardiac arrest after near drowning. To date, results from available studies enrolling patients resuscitated from asystolic cardiac arrest have failed to show statistically significant treatment benefit. We describe the management of a patient with asystolic cardiac arrest after drowning in whom therapeutic hypothermia was used.

Asystolic Cardiac Arrest from Near Drowning Managed with Therapeutic Hypothermia