Conflict of Interest Declaration
The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: None
The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: None
Task Force Scoping Review Citation
Bierens J, Barcala-Furelos R, Beerman S, Claesson A, Dunne C, Elsenga H, Abelairas-Gomez C, Morgan P, Mecrow T, Pereira JCC, Scapigliati A, Seesink J, Schmidt A, Sempsrott J, Szpliman D, Warner DS, Webber J, Johnson S, Avis S, Mancini MB, Nation K, Brooks S, Castren M, Chung S, Considine J, Kudenchuk P, Nishiyama C, Ristagno G, Semeraro F, Smyth M, Vaillancourt C, Olasveengen T, Morley P, Perkins GD on behalf of the International Liaison Committee on Resuscitation Basic Life Support Task Force(s).
Resuscitation on a boat following drowning. Review and Task Force Insights [Internet] Brussels, Belgium: International Liaison Committee on Resuscitation (ILCOR) Basic Life Support Task Force, 7 July 2020. Available from: http://ilcor.org
Methodological Preamble and Link to Published Scoping Review
The continuous evidence evaluation process started with a scoping review of the literatures undertaken by Roberto Barcala Furelos and Jeroen Seesinkand, co-ordinated by Gavin Perkins and Joost Bierens. The findings from the review of basic life support were considered by the Basic Life Support Task Force who contributed to the Task Force insights.
Scoping Review
Webmaster to insert the Scoping Review citation and link to Pubmed using this format when/if it is available.
PICOST
The PICOST (Population, Intervention, Comparator, Outcome, Study Designs and Timeframe)
Population: In adults and children who are submerged in water
Intervention: Delivering resuscitation in a boat
Comparators: Delaying resuscitation until on dry land
Outcomes: Any clinical outcome (e.g. survival, survival with a favourable neurological outcome, hospitilisation), CPR quality, physiological end-points
Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies) are eligible for inclusion. Manikin studies will only be included if no human studies are available.
Timeframe: From 2000 onwards. All languages were included as long as there was an English abstract; unpublished studies (e.g., conference abstracts, trial protocols), narrative reviews, animal studies were excluded. Literature search updated to October 2019.
Search Strategies
BLS-856-Drowning-CPR-Search-Strategies
Inclusion and Exclusion criteria
Inclusion criteria:
- Adult and paediatric patients
- Submersion in water (drowning, near drowning)
- Describe initiating resuscitation on a boat
- Studies report clinical outcomes e.g. survival, survival with a favourable neurological outcome, hospitilisation
- Other outcomes: CPR quality, physiology
Exclusion criteria:
- Animal studies
- Results reported in the gray literature or abstract only
- Narrative reviews containing no primary data
- Published as an abstract only or in conference proceedings.
- Case studies / series without control groups, unless no or minimal other literature available.
Data tables
Task Force Insights
1. Why this topic was reviewed.
Drowning is the third leading cause of unintentional injury death worldwide, accounting for over 360 000 deaths annually.[World Health Organization, 2020] Submersion in water leads to the rapid onset of hypoxia. Left untreated cardiac arrest occurs within minutes. Early initiation of resuscitation is likely to lead to the best outcomes. Starting resuscitation on a rescue boat is one approach to enable early initiation of resuscitation. However, the feasibility and effectiveness of CPR on a boat has not previously been explored. The BLS Task Force and Drowning collaboration considered it timely to undertake a scoping review of the literature to identify evidence related to this topic.
2. Narrative summary of evidence identified
The literature search identified 3005 articles (2190 after removal of duplicates). After screening titles and abstracts, eight studies were identified for full text review. Of these, six studies evaluated resuscitation in a boat. Two were clinical studies undertaken in the Netherlands[Seesink, 2019, 104] and Hawaii.[Kingdon, 2016, 432] and 4 were manikin studies.[de Vries, 2006, 247; Tipton, 2007, 332; Barcala-Furelos, 2017, 370; Fungueirino-Suarez, 2018, 2747046]
A case series from the Royal Dutch Lifeboat Institution reported on 37 patients who had received resuscitation from lifeboat crews.[Seesink, 2019, 104] Amongst these 24 cases included resuscitation on a lifeboat or another ship. There were only 3 survivors, none of whom received resuscitation on a boat. An AED was used in 12 patients (7 drowned and 4 not drowned, 1 unknown location of use undefined). Three shocks were delivered; CPR quality was reported as sub-optimal (high compression frequency and long pauses in chest compressions). In the other case series, 6 resuscitations were attempted on a boat or lifeboat, there was only one survivor after one month who received BLS, ALS and ETI on board.[Kingdon, 2016, 432]
Three simulation crossover studies evaluated the capacity of lifeguards[Tipton, 2007, 332; Barcala-Furelos, 2017, 370] and fishermen[Fungueirino-Suarez, 2018, 2747046] to perform CPR on inflatable rescue boats or fishermen traditional boats. These studies showed that resuscitation on a boat was feasibility, however quality of the resuscitation was affected by the boat speed[Barcala-Furelos, 2017, 370; Fungueirino-Suarez, 2018, 2747046] and sea conditions.[Tipton, 2007, 332] CPR was physically demanding. [Tipton, 2007, 332; Barcala-Furelos, 2017, 370; Fungueirino-Suarez, 2018, 2747046] The motion-induced and early fatigue mainly affect to ventilations.[Tipton, 2007, 332] A further simulation study showed that AED use on rigid inflatable rescue boats (RIBs) on calm water was feasible.[de Vries, 2006, 247]
3. Narrative Reporting of the task force discussions
A limited evidence base was identified in this scoping review, but a systematic review on this topic will be required if a recommendation is intended to be made by the task force.
From the available evidence, resuscitation in a boat seems feasible if safety conditions, number of crew and deck-space allows this, but those providing resuscitation needed to focus on high quality CPR and be alert to the development of fatigue.