Submersion and Early-Onset Acute Respiratory Distress Syndrome: A Case Report

Abstract

Drowning is a common cause of accidental death, particularly in younger people, and acute respiratory failure is common in these patients. This case report describes a healthy 18-year-old man who suffered a cardiorespiratory arrest due to submersion while swimming in a freshwater lake. First-responder cardiopulmonary resuscitation and defibrillation using an automated external defibrillator resulted in a return of spontaneous circulation. The patient was evacuated to a tertiary care center by a rotor-wing air medical crew. The crew experienced difficulties in oxygenating and ventilating the patient because of early-onset acute respiratory distress syndrome (ARDS). This case report describes the pathophysiology and prehospital management of a patient with suspected early-onset ARDS secondary to drowning. This case report is unique because it describes the oxygenation and ventilation difficulties encountered in managing this patient in the transport setting, and possible strategies to deal with these difficulties. Finally, this case report highlights the prehospital bypass decision-making process for patients requiring specialized medical care.

Hypothesized mechanisms of death in swimming: a systematic review

“…A study of 16 drowning cases, 4 of which died of dangerous underwater breath-holding behaviors (DUBBs), including intentional hyperventilation, static apnea, and hypoxic training [ 24 ]. Another study showed that a healthy 18-year-old male swimmer who suffered cardiopulmonary arrest while swimming in a freshwater lake is suspected to have died of secondary acute respiratory distress syndrome (ARDS) [ 25 ].…”

“…Respiratory diseases are thought to be not completely reliable to the hypothesized swimming death mechanisms because few cases are supporting this mechanism. The included respiratory failure death cases are related to two concepts, DUBBs and ARDS [ 24 , 25 ]. Hyperventilation or breath-holding before diving or swimming reduces the body's storage of CO 2 and carbon dioxide partial pressure (PCO 2 ) to delay the brain's response to surface breathing which is an effective technique to trick their bodies into delaying the stimulation of breathing, thereby improving swimmers' performance.…”