
==== Front
Resusc Plus
Resusc Plus
Resuscitation Plus
2666-5204
Elsevier

S2666-5204(24)00202-9
10.1016/j.resplu.2024.100751
100751
Letter to the Editor
Reply to: Comment on the use of the HOPE score in the specific case of drowning resuscitation
Seesink Jeroen jeroenseesink@gmail.com
⁎
Department of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
van der Wielen Wietske
Amsterdam University Medical Centre, Amsterdam, the Netherlands
Dos Reis Miranda Dinis
Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
Department of Intensive Care, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
Moors Xavier J.R.
Department of Anaesthesiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
Helicopter Emergency Medical Services, Trauma Centre Zuid-West Nederland, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
⁎ Corresponding author: Department of Anaesthesiology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands T: +31636066099. (J. Seesink) jeroenseesink@gmail.com
24 8 2024
12 2024
24 8 2024
20 1007518 8 2024
11 8 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
==== Body
pmcDear Editor,

With great interest, we have read the response from Hall et al., to our case report on “successful prehospital ECMO in drowning resuscitation after prolonged submersion” regarding the use of the HOPE score in this context.1 We appreciate this valid response to initiate the discussion on this matter and would therefore like to respond.

As correctly indicated by Hall et al., the HOPE score estimates the likelihood of survival at hospital discharge after rewarming using extracorporeal life support (ECLS) in patients with hypothermic cardiac arrest (CA). This score is intended to guide the decision-making process regarding whether to initiate ECLS after hospital admission.

To clarify, the HOPE score was not utilized in the decision to start prehospital ECLS in this case. As in this case, not all variables are often available prehospitally, as potassium is not typically measured in this setting.2 In the absence of a reliable decision score for initiating prehospital ECLS, we retrospectively determined the HOPE score at the time of hospital admission to provide perspective for this unique situation. The score of 5% is therefore based on an 18-year-old male, with a resuscitation duration of 15 min, asphyxia, a potassium level of 3.4 mmol/L, and a temperature of 32.4 degrees Celsius. Hall et al. rightly noted that it is unlikely that the potassium level used to calculate HOPE at hospital admission corresponds to the value at water extrication or to the hypothetical value during ongoing cardiopulmonary resuscitation upon hospital arrival. If we had simulated the prehospital moment of extrication with his temperature at 30.5 °C and the same estimated potassium level, the resulting HOPE score would have been 16%.

The suggestion by Hall et al. to assume the most favorable scenario in cases of uncertainty between immersion and submersion seems insufficiently nuanced to us. We are aware that extended submersion times are associated with significantly poor neurological outcomes, and that advanced life support for longer than 30 min in children in the Netherlands has resulted in no neurologically favorable survivors.3, 4 Additionally, prehospital ECLS is a very costly method that should not be used too readily.5 Therefore, it is important to make an individual assessment for each case. Situations that enhance survival rates include prolonged immersion and the onset of hypothermia prior to submersion, particularly in extremely cold conditions or when an underwater air source is available (e.g., a diver, a capsized boat, or a submerged car).3

In conclusion, we suggest that the development of a new scoring system to guide the decision to initiate ECLS in patients with hypothermic CA in the prehospital setting would be useful.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
==== Refs
References

1 Seesink J. van der Wielen W. Dos Reis Miranda D. Moors X.J.R. Successful prehospital ECMO in drowning resuscitation after prolonged submersion Resusc Plus 19 2024 100685 10.1016/j.resplu.2024.100685
2 Kim C. Kim H. Emergency medical technician-performed point-of-care blood analysis using the capillary blood obtained from skin puncture Am J Emerg Med 36 2018 1215 1221 10.1016/j.ajem.2017.12.025 29519760
3 Szpilman D. Morgan P.J. Management for the drowning patient Chest 159 2021 1473 1483 10.1016/j.chest.2020.10.007 33065105
4 Kieboom J.K. Verkade H.J. Burgerhof J.G. Outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study BMJ 350 2015 h418 10.1136/bmj.h418
5 Ali S. Moors X. van Schuppen H. A national multi centre prehospital ECPR stepped wedge study; design and rationale of the ON-SCENE study Scand J Trauma Resusc Emerg Med 32 2024 31 10.1186/s13049-024-01198-x 38632661
