Building a Foundation for Better Pediatric Drowning Resuscitation
Drowning remains a major cause of preventable injury and death in children, particularly among those younger than five years. Yet despite its global importance, remarkably little scientific evidence is available to determine the best way to perform cardiopulmonary resuscitation following pediatric drowning.
Our latest publication in Resuscitation Plus, “An innovative porcine model of pediatric drowning,” describes a new preclinical model designed to help address this critical evidence gap.
Drowning primarily causes respiratory impairment. As oxygen levels fall, progressive hypoxia and acidosis can ultimately lead to cardiac arrest. Rapid restoration of oxygenation, ventilation, and circulation is therefore essential. However, many pediatric resuscitation recommendations continue to be extrapolated from adult clinical studies or adult animal models. These findings may not fully reflect the anatomy, physiology, and resuscitation needs of infants and young children.
A controlled and reproducible model
Our research team developed a pediatric piglet model that reproduces the physiological changes associated with drowning-induced hypoxia without requiring full-body submersion.
Piglets have several important anatomical and physiological similarities to young children, including comparable airway dimensions, chest geometry, body size, and cardiopulmonary responses to hypoxia and resuscitation. This makes the model highly relevant for studying pediatric cardiac arrest and CPR.
The controlled laboratory approach also allows researchers to regulate factors such as fluid type, temperature, oxygenation, and ventilation. At the same time, advanced monitoring provides continuous information about blood pressure, carotid blood flow, cerebral oxygenation, ventilation, and blood-gas changes.
In the initial group of ten piglets, the model produced substantial and consistent physiological changes characteristic of severe drowning-induced hypoxia. These included marked reductions in blood pressure, cerebral blood flow, cerebral oxygenation, and arterial oxygen levels, accompanied by increasing carbon dioxide, lactate, and acidosis.
One model, many research questions
This model creates an opportunity to systematically investigate many unanswered questions in pediatric drowning resuscitation.
Future studies could compare different CPR approaches, including airway-breathing-circulation versus circulation-airway-breathing sequences, conventional pediatric CPR, and alternative chest-compression and ventilation techniques. Researchers could also examine different oxygen concentrations, ventilation strategies, medications such as epinephrine and vasopressin, temperature management, and different drowning environments.
Because detailed monitoring can continue after return of spontaneous circulation, the model can also be used to study cardiovascular recovery, cerebral oxygen delivery, neurological outcomes, inflammation, and post-resuscitation treatments.
From laboratory research to better resuscitation
This study does not identify the optimal resuscitation strategy—that work comes next. Instead, it establishes the platform needed to compare potential treatments under controlled and reproducible conditions.
By providing a dedicated model for pediatric drowning research, we hope to generate the evidence required to strengthen future resuscitation recommendations and ultimately improve outcomes for children.
Training the next generation of researchers
This new model is already supporting trainee-led research. This fall, three University of Alberta undergraduate students will undertake projects related to pediatric drowning. BIOL 499 student Prabhnoor Jagdav will investigate VEGFA expression in peripheral blood mononuclear cells as a potential biomarker of hypoxic stress during and after drowning in children. PHYSL 468/469 students Jessica Gill and Pricilla Oladele will examine different chest-compression techniques using our newly established pediatric piglet drowning model.
By involving undergraduate students at this early stage, the program is not only generating new evidence but also helping train the next generation of researchers in pediatric resuscitation science.
Read the open-access article in Resuscitation Plus: https://doi.org/10.1016/j.resplu.2026.101460
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