Sir.—In read with interest the article by Nussbaum1 concerning the prognosis for comatose, nearly drowned children. I recently evaluated all the near-drownings seen in the Pediatric Intensive Care Unit at Valley Children's Hospital, Fresno, Calif, from 1977 to 1982 (total, 100 patients). Thirty-three patients were in a deep coma. The variables reviewed by Nussbaum were looked at, as was the treatment method (all patients were paralyzed, oxygenated, and monitored closely). Additional therapeutic modalities, including hypothermia, barbiturate-induced coma, steroids, and osmotherapy, made no difference. The only significant variable in our patients was the status on arrival at the emergency room (ours or another hospital's) where the child was first seen.
Of the 33 comatose patients, 22 arrived in the emergency room with no spontaneous respiratory effort and no perfusing heartbeat (asystole or ventricular fibrillation). All these patients needed advanced cardiac life support before a heartbeat could be established and