Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. This impairment rapidly leads to a lack of oxygen in the body’s tissues, which is the primary cause of injury and death in these incidents. Unlike cardiac arrests that result from a heart condition, a drowning event represents a primary respiratory issue that then causes the heart to stop secondarily. Because of this mechanism, the standard cardiopulmonary resuscitation (CPR) protocol must be modified to prioritize oxygen delivery. Understanding and immediately implementing this specific sequence is necessary for anyone attempting to save a victim of non-fatal drowning, increasing the likelihood of a successful outcome by addressing severe oxygen deprivation.
Prioritizing Ventilation Over Compressions
The fundamental difference between cardiac arrest from drowning and a typical adult cardiac arrest lies in the root cause of the problem. A heart attack usually causes the heart to stop first, making chest compressions the initial intervention in standard CPR. For a drowning victim, the sequence is inverted: the person stops breathing first due to the liquid environment, leading to a severe lack of oxygen, known as hypoxia. This hypoxia then causes the heart to slow and eventually stop, resulting in a hypoxic cardiac arrest.
Since the circulating blood still contains some oxygen, the immediate need is to resupply the lungs with fresh oxygen. Therefore, established guidelines mandate a shift from the standard C-A-B (Compressions, Airway, Breathing) sequence to a ventilation-first approach. The immediate provision of ventilations is intended to re-oxygenate the blood, which offers the best chance for the heart to restart or for the victim to resume spontaneous breathing.
Executing the Drowning CPR Sequence
The immediate intervention for a non-breathing drowning victim begins with the delivery of initial rescue breaths. After removing the victim to a safe, firm surface, the rescuer should open the airway using the head-tilt/chin-lift technique. This protocol requires five initial rescue breaths immediately after checking for unresponsiveness and before initiating chest compressions.
To deliver these breaths effectively, the rescuer must pinch the victim’s nose shut, create a tight seal over the mouth, and blow in until the chest visibly rises. Each breath should last approximately one second and should be repeated five times in quick succession. If the chest does not rise during a breath, the rescuer should reposition the head and attempt the breath again, as this indicates a blocked airway.
Once the five initial breaths are delivered, the rescuer transitions into the standard cycle of chest compressions and ventilations. For an adult victim, this ongoing cycle involves 30 chest compressions followed by two rescue breaths, maintaining a 30:2 ratio. Compressions should be performed at a rate of 100 to 120 per minute, pushing hard and fast in the center of the chest to a depth of at least two inches.
For infants and children, the core principle of five initial rescue breaths remains the same. If a single rescuer is present, the 30:2 ratio is still used. If two trained rescuers are available, the ratio for a child is reduced to 15 compressions for every two breaths. This higher frequency of ventilation is necessary because children are more susceptible to hypoxic injury, and their cardiac arrests are almost always respiratory in nature.
Scene Safety, Assessment, and Ongoing Care
Before any resuscitation efforts begin, the rescuer must prioritize their own safety to avoid becoming a second victim. This involves assessing the danger and using non-contact methods, such as reaching or throwing a flotation device, before considering entering the water. Once the victim has been safely removed from the water and placed on a firm surface, the initial assessment for unresponsiveness and lack of breathing should be performed.
The rescuer should then immediately activate emergency medical services by calling for help or instructing a bystander to call 911. If the rescuer is alone and the victim is an adult, they should call first. If the victim is a child or the event was unwitnessed, the rescuer should perform two minutes of CPR before calling for help, as immediate oxygen is paramount in these cases.
Once CPR is underway, the rescuer must be prepared to manage complications, particularly vomiting, which is common in drowning events. If the victim regurgitates, the rescuer should quickly turn the victim onto their side to clear the mouth and airway before returning them to a flat position to continue CPR.
Continuous CPR should be maintained until emergency professionals arrive, the victim shows definitive signs of life, or the rescuer is too exhausted to continue.
Even if the victim revives and appears fine, they require immediate transportation to a medical facility for examination. Water in the lungs can cause chemical irritation and inflammation that may lead to complications, such as pulmonary edema, which can be life-threatening. Medical assessment is necessary because symptoms like persistent coughing, difficulty breathing, or lethargy can appear hours after the initial incident.