Drowning is the third leading cause of death from unintentional injury worldwide, accounting for 7% of all injury-related deaths. The World Health Organization estimates that there are ≈236 000 deaths due to drowning worldwide each year. Significant efforts have focused on creating systems to prevent drowning, but an average of 4000 fatal and 8000 nonfatal drownings still occur annually in the United States-likely an underestimate. Drowning generally progresses from initial respiratory arrest due to submersion-related hypoxia to cardiac arrest; thus, it can be challenging to distinguish respiratory arrest from cardiac arrest because pulses are difficult to accurately palpate within the recommended 10-second window. Therefore, resuscitation from cardiac arrest attributable to this specific circumstance must focus on restoring breathing as much as it does circulation. Resuscitation from drowning may begin with in-water rescue breathing when safely provided by rescuers trained in the technique and should continue with chest compressions, in keeping with basic life support guidelines, once the drowned individual and the rescuer are in a safe environment (eg, dry land, a boat). This focused update incorporates systematic reviews from 2021 to 2023 performed by the International Liaison Committee on Resuscitation related to the resuscitation of drowning. These clinical guidelines are the product of a committee of experts representing the American Heart Association and the American Academy of Pediatrics. The writing group reviewed the recent International Liaison Committee on Resuscitation systematic reviews, including updated literature searches, prior guidelines related to resuscitation from cardiac arrest following drowning, and other drowning-related publications from the American Heart Association and American Academy of Pediatrics. The writing group used these reviews to update its recommendations aimed at resuscitation of cardiac arrest following drowning in adults and children.

AIM This study aimed to examine the total causal effect of bystander cardiopulmonary resuscitation (BCPR) type and 1-month survival in cases of drowning following out-of-hospital cardiac arrest (OHCA) in natural water bodies. METHODS This retrospective cohort study used the Utstein style database and the Emergency Transport Registry of Japan from 2016 to 2022. We included cases of drowning following OHCA in natural water bodies (e.g., sea, river/pond). BCPR was categorized as no-BCPR, hands-only CPR (chest compressions only), and conventional CPR (chest compressions with rescue breathing). Multivariable logistic regression analysis was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS A total of 3914 patients were eligible for analysis (no-BCPR, n = 2633 [67.3%]; hands-only CPR, n = 1049 [26.8%]; conventional CPR, n = 232 [5.9%]). The proportion of 1-month survival was 2.7% for no-BCPR, 9.4% for hands-only CPR, 24.1% for conventional CPR. Multivariable logistic regression analysis revealed that compared with no-BCPR, both conventional CPR (AOR [95% CI], 3.70 [2.31-5.93]) and hands-only CPR (AOR [95% CI], 1.74 [1.19-2.54]) were positively associated with 1-month survival. Furthermore, hands-only CPR and conventional CPR was positively associated with 1-month survival (AOR [95% CI], 2.13 [1.41-3.23]). CONCLUSION In cases of drowning following OHCA in natural water bodies, both conventional CPR and hands-only CPR indicated a beneficial causal effect on 1-month survival compared to no-BCPR, with conventional CPR showing greater causal effect. These findings support prioritizing conventional CPR for drowning following OHCA in natural water bodies.

Introduction: The effectiveness of compression-only cardiopulmonary resuscitation (CPR) has been well-documented in cardiac-origin out-of-hospital cardiac arrest (OHCA). However, for non-cardiac etiologies such as drowning, conventional CPR with rescue breathing is recommended in guidelines based primarily on expert opinion, with limited evidence supporting its superiority. Objectives: To evaluate the association between bystander CPR type and neurologically favorable survival in drowning-related OHCA. Methods: This retrospective observational study analyzed nationwide Utstein data from Japan between 2013 and 2021. Drowning-related OHCA patients were categorized into three groups: no bystander CPR, compression-only CPR, and conventional CPR. The primary outcome was neurologically favorable survival at 30 days. Multivariable logistic regression with Firth's bias reduction method was used to adjust for potential confounders including year, gender, age, physician presence, witness status, public-access defibrillation, initial rhythm, airway management, adrenaline administration, and time intervals. Results: Among 29,680 drowning-related OHCA patients, 52.6% received no bystander CPR, 41.7% received compression-only CPR, and 5.6% received conventional CPR. Unadjusted rates of neurologically favorable survival were 0.31%, 2.01%, and 10.43%, respectively. After adjustment for confounders, both compression-only CPR (adjusted odds ratio [AOR]: 3.30, 95% CI: 2.31-4.72, p<0.001) and conventional CPR (AOR: 6.45, 95% CI: 4.19-9.93, p<0.001) were associated with significantly higher odds of neurologically favorable survival compared to no bystander CPR. Conventional CPR showed significantly better outcomes compared to compression-only CPR (AOR: 1.95, p<0.001). Adjusted predicted probabilities were 0.09% (95% CI: 0.06-0.12%) for no bystander CPR, 0.28% (95% CI: 0.21-0.37%) for compression-only CPR, and 0.55% (95% CI: 0.38-0.81%) for conventional CPR. Conclusions: In drowning-related OHCA, both types of bystander CPR were associated with improved neurologically favorable survival. However, conventional CPR with rescue breathing resulted in significantly better outcomes than compression-only CPR. These findings support current guideline recommendations for conventional CPR in drowning-related cardiac arrest.

The 2025 Korean basic life support guidelines are evidence-based treatment recommendations for basic cardiopulmonary resuscitation (CPR). The 2025 guidelines recommend that after checking the response of a patient suspected of cardiac arrest, call 119 (emergency medical services) immediately and request an automated external defibrillator (AED) before performing procedures to confirm cardiac arrest, such as checking breathing. There is currently insufficient evidence into the clinical effectiveness of dispatcher actively instructing individuals who report an emergency to retrieve and use an AED, but one observational study reported an increase in some survival rates. The guidelines recommend that lay rescuers and emergency medical personnel who have been trained in and are willing to perform artificial ventilation should apply standard CPR including artificial ventilation, and that lay rescuers who are not trained in or do not want to perform artificial ventilation should perform compression-only CPR. The guidelines emphasize high-quality CPR, including effective chest compressions and ventilation. The application of a rapid AED is continuously emphasized, and the anterolateral positioning method is recommended as a priority for ease of application. Healthcare workers are recommended to perform standard CPR with a compression to ventilation ratio of 30:2 for patients suspected of having a high-risk pathogen infection and to wear appropriate personal protective equipment, including a mask or respirator appropriate for the suspected pathogen, gloves, a gown, and eye protection.

The 2025 update of the Korean guidelines for cardiac arrest under special circumstances incorporates new evidence and expert consensus to clarify when clinicians should modify standard resuscitation algorithms. For cardiac arrest caused by acute hyperkalemia, the guidelines suggest administering intravenous insulin with glucose; however, current evidence remains insufficient to recommend for or against routine use of sodium bicarbonate or calcium. In suspected pulmonary embolism-related cardiac arrest, thrombolytic therapy may be considered. In confirmed cases, thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy may be appropriate, despite very low certainty of evidence. For opioid-related cardiac arrest, current evidence does not support the routine administration of naloxone in addition to standard advanced life support; however, naloxone may be administered when it is unclear whether the patient is in true cardiac arrest. The guidelines also emphasize managing cardiac arrest in the prone position. If the patient is intubated and immediate repositioning is unsafe or impractical, prone cardiopulmonary resuscitation and defibrillation may be attempted using invasive arterial pressure or end-tidal carbon dioxide monitoring to guide the timing of repositioning. Immediate supination is strongly recommended for non-intubated patients. Additional updates address drowning, severe hypothermia, pregnancy, anaphylaxis, and cardiac arrest during interventional procedures, underscoring the importance of early correction of reversible causes, appropriate airway strategies, and timely consideration of extracorporeal life support in selected cases. Overall, the 2025 recommendations highlight cautious, etiology-directed interventions and explicitly grade recommendation strength and certainty to support context-sensitive clinical decision-making in high-risk and resource-variable settings.