Those are some pretty dismal statistics, K_Z.
I already knew that the stats on people who suffer cardiac arrest in the field were bad, particularly those in asystole, but hadn't really seen much on drownings.
Yeah, these stats are very hard to absorb, and pretty unequivocal. The main study I quoted is a Japanese longitudinal study that ultimately looked at over 60,000 drownings-- most of which were babies, toddlers, and children. I didn't do a very comprehensive lit review, and I still have about 5 other drowning studies that are similarly dismal that I didn't post, including a study and 2 opinion pieces that question the value of prolonged ER advanced resuscitation for drowning victims with cardiac arrest, since the neuro outcomes are are so very dismal.
As rapid EMS care, resuscitative medicine, and ICU care have become more sophisticated, both good and miraculous outcomes, and difficult vegetative outcomes have emerged. Scientist physicians and epidemiologists strive to research, assess, and evaluate the best methods to produce the best neurological outcomes. There is widespread concern and "discomfort" among physicians, health care providers, and scientists about employing aggressive methods for cases that produce cardiac resuscitation (a functional heartbeat and circulation), with profound and permanent neurological devastation. No one knows what the "right" amount of resuscitation and aggressive treatment is, and most people want to grasp onto the hope that their loved one will beat the odds and be the one in a million (or 1 or 2 in 10,000) miracle case.
Scientists and researchers are now, in the past 15 years or so, more closely concentrating attention not only on the question of how many people "survive" a situation (for example) of OHCA (out of hospital cardiac arrest), but to attempt to objectively quantify what kind of neurological outcome the survivors have. Rearchers strive to identify what kind of outcomes are statistically probable with various situations that produce OHCA, in order to better identify protocols to help the ones who can be helped to recover to some level of functioning. And yes, they also identify "medically futile" situations, in order to make THE BEST and MOST EFFECTIVE recommendations for resuscitation, once a patient is delivered to a trauma center or ER. Scientists, researchers, and physicians
do actually understand and empathize with how bewildering, painful, and confusing it is to place the decision for continued care that is at best uncertain, and at most, futile, in the hands of grieving loved ones.
And this is where "consensus conferences" and consensus opinions of highly specialized researchers and scientists, and professional organizations come into play. As data is researched and established to define what kind of outcomes occur with various treatments, recommendations emerge. An example is the newer recommendations that for children with cardiac arrest after non-hypothermic submersion, CPR and ACLS resuscitation efforts should be terminated after 30 minutes of cardiac arrest.
Here is an example of an evaluation scale that has been developed (2011) for Cerebral Performance Categories. Category 1 and 2 is considered a "favorable outcome" after out of hospital cardiac arrest. Categories 3, 4, and 5 are "unfavorable". While these
are not "death panel" recommendations, or even binding in any way, they are guidelines intended to help physicians evaluate options, and explain to families the outcomes that are most likely, given the circumstances of the person's cardiac arrest. (I hope that makes sense.)
http://neurodss.com/details.php?id=154 (Because of the way this tool is developed and utilized, it is not subject to copyright the way MSM articles are, and I can copy here in its entirety. For that same reason, I can only post abstracts of some articles I quote, even though I have access to full text, due to copyright, as well as my use of certain databases I have access to.)
Cerebral Performance Category
Neurol outcome after cardiac arrest
CPC 1
Good cerebral performance (normal life).
Details: Conscious, alert, able to work and lead a normal life. May have minor psychological or neurologic deficits (mild dysphasia, nonincapacitating hemiparesis, or minor cranial nerve abnormalities).
CPC 2
Moderate cerebral disability (disabled but independent).
Details: Conscious. Sufficient cerebral function for part-time work in sheltered environment or independent activities of daily life (dress, travel by public transportation, food preparation). May have hemiplegia, seizures, ataxia, dysarthria, dysphasia, or permanent memory or mental changes.
CPC 3
Severe cerebral disability (conscious but disabled and dependent).
Details: Conscious; dependent on others for daily support (in an institution or at home with exceptional family effort). Has at least limited cognition. This category includes a wide range of cerebral abnormalities, from patients who are ambulatory but have severe memory disturbances or dementia precluding independent existence to those who are paralyzed and can communicate only with their eyes, as in the locked-in syndrome.
CPC 4
Coma or vegetative state (unconscious).
Details: Unconscious, unaware of surroundings, no cognition. No verbal or psychologic interaction with environment.
CPC 5
Brain death
Details: Certified brain dead or dead by traditional criteria.
Reference
Ajam K, Gold LS, Beck SS, Damon S, Phelps R, Rea TD. Reliability of the Cerebral Performance Category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011; 19:38.
