CARDIOVASCULAR

Low output heart failure and lethal dysrhythmias are common in drowning victims. While hypoxemia is the primary driver of these conditions, correction of hypoxemia may not immediately restore normal cardiac function and ICU physicians should be prepared to manage these issues. Reduced cardiac output may lead to cardiogenic component of pulmonary edema or worsen additional organ failure (e.g., cardiorenal syndrome).1

- Consider echocardiogram initially. In patients requiring inotropic support, consider cardiac output monitoring through either noninvasive cardiac output monitoring, pulse contour analysis, or pulmonary artery catheter.
- Maintain MAP goal of >65mmHg. Stroke volume variation can be utilized to identify patients that may be volume responsive and should be given additional crystalloid resuscitation. Judicious fluid resuscitation should be maintained.
- Patients who are not volume responsive and remain hypotensive should receive vasopressor support. Again, be sure to rule out traumatic injury and hemorrhage as a cause of hypotension.
- Patients should remain on continuous telemetry to assess for dysrhythmias.
- EKG or telemetry may demonstrate the presence of Osborne waves or J Waves (extra deflection at the end of the QRS complex) in the hypothermic patient. See Figure 3 below.