[Near-Drowning with Good Outcome after ECMO-Therapy and Therapeutic Hypothermia Despite 20 Minutes of Anoxia and 16 Hours of Hypoxia].

Drowning with submersion over 10 minutes is associated with a high mortality. Here, we present a case, in which a good neurological outcome was achieved after interdisciplinary, intensive care therapy despite submersion of 20 minutes followed by 16 hours of hypoxia.  A 19 year old man drowned in fresh-water. After 20 minutes submersion he was localized and salvaged from 8 meters depth and primarily resuscitated successfully after 10 minutes. Within the next hour, there condition worsened by respiratory deterioration due to a massive capillary leak syndrome in addition to a disseminated intravascular coagulation.  This made implantation of a veno-venous ECMO (extracorporeal membrane oxygenation) therapy necessary. Despite intensive care medicine including extracorporeal therapy a sufficient oxygenation (arterial pO > 60 mmHg) was reached only 16 hours after the drowning.  During this time the patient was treated with a mild therapeutic hypothermia for cerebral protection. Despite the prolonged hypoxia, ECMO could be removed five days after the drowning and the patient was extubated after another five days without significant neurological deficits.  Despite submersion of 20 minutes followed by prolonged hypoxia, a good neurological outcome could be achieved in our patient. This case suggests, that tolerance of hypoxia is possibly underestimated after drowning.