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Cold-water immersion arrest — DIPIMC MCQ

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HardEnvironmental MedicineCold-water immersion arrestDIPIMCDipIMC

A teenager is pulled from an icy lake after a prolonged submersion in very cold water and is in cardiac arrest. Bystanders estimate he was under water for around 25 minutes. How should the duration and conduct of resuscitation be approached?

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Correct answer: C — Prolonged resuscitation is justified because deep cold is protective

Submersion in very cold water can be protective, and good neurological recovery has been reported after prolonged immersion, so resuscitation is continued and the patient rewarmed rather than stopped early. Applying normothermic time limits, or limiting shocks, would inappropriately curtail a potentially survivable arrest. Drowning is a hypoxic arrest, so rescue breaths are important. Pearl: in hypothermic drowning, resuscitation is generally continued until the patient is rewarmed, ideally in a centre able to provide extracorporeal rewarming.

Reference: Resuscitation Council UK Guidelines 2025 (Special Circumstances)