This issue of Resuscitation includes a large prognostic Utstein-based drowning resuscitation study from Osaka, Japan, which at first glance reports very disappointing outcomes. Of the 1737 drowning victims who were in a cardiac arrest at arrival of emergency medical services (EMS), only 0.8% were alive with normal neurological function after one month.1 The study is consistent with another Japanese cohort study,2 but contrasts with case reports where more optimistic outcomes have been reported.3'4 A conclusion of the current publication could be that resuscitation of drowning victims is useless and that we should perhaps return to the 17th century when the laws in many European countries required that drowning victims remain untouched with at least their feet hanging in the water so as to allow police to determine the cause of death.The work of Nitta et al. emphasises the reality of the down-side of resuscitation efforts and the importance of effective drowning prevention strategies. At the same time, the study allows us to learn more about some key elements of drowning resuscitation and research.
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