Drowning & Aspiration of Sand & Saltwater

Survival of Salt Water and Sand Aspiration

This middle-aged woman drove her SUV to a beach on the Oregon coast to watch the ocean in a winter storm. She parked her vehicle on the beach, about 100 yards from the surf. A “sneaker” wave, much larger than usual, swept up the beach and washed her under her SUV and trapped her there. She inhaled sand and salt water, causing acute respiratory distress. Bystanders pulled her from underneath her car and tried first aid, to no avail.

 Someone called 911. Rural EMTs arrived 10 min. later, and were unable to insert an airway because of thick sand in her mouth and throat. They transported her to Tillamook General Hospital (TGH) where an emergency physician managed to clear most of the sand from her mouth and throat, and see well enough to insert an endotracheal tube in her trachea, so that she could get assisted breathing and oxygen. 

The weather precluded the Life Flight EMS helicopter from flying to Tillamook to transport her to Portland. TGH loaded her into a land ambulance to take her to Emanuel Hospital, a trip that normally would take about one hour, but under bad weather, the trip would take at least 1.5 hours. En route, her oxygen saturation monitor showed decreasing oxygen saturations, and she became bradycardic. EMTs tried to suction her endotracheal tube (ETT), but sand clogged their suction catheters. The EMTs decided to remove her ETT, and bag valve mask her for the rest of the journey. She lost all vital signs during the last 30 min. of her journey. 

Fortunately, the TGH emergency physician called the Emanuel Hospital trauma surgeon, and told him of what happened. That information enabled the Emanuel Trauma Team to call a Cardiothoracic surgeon, who in turn called in a perfusionist to prime the portable CPB machine. EMTs took her directly to the Trauma operating room, where the trauma anesthesiologist was able to clear sand from her hypopharynx and insert an ETT and start to ventilate her. Concurrently, I was the cardiothoracic surgeon who cannulated left common femoral artery and vein and initiated cardiopulmonary partial bypass, which can provide her needs for organ and tissue perfusion and oxygen, and remove carbon dioxide, even if her lungs were filled with sand and saltwater. 

Once we had her heart working, we were now faced with the problems of how to remove the sand from all her major airways, so that she could breathe with no airway obstructions. I was trained at UCSD Hospital by James Harrell, eminent pulmonologist and bronchoscopist, in both flexible and rigid bronchoscopy. There was too much sand in the trachea to even attempt flexible bronchoscopy, and removal of sand with biopsy forceps. We asked the anesthesiologist to insert a smaller ETT so that I could insert a large rigid bronchoscope and we set up a trachea-bronchial irrigation and suction system to remove the sand in her main airways. We were able to do this.

A portable chest x-ray showed evidence of sand crystals still lining the smaller airways, beyond the reach of the rigid bronchoscope and irrigation system. Worried about sand obstruction of the small airways, we opted to transfer her on CPB to the ICU where we placed her in the prone position and used a percussion device to see if we move sand from the smaller airways to the larger airways where we could suction it out. Two days later, her pulmonary function and oxygen exchange was near normal, and we were able to stop the CPB and extubate her. We discharged her home three days later. She survived neurologically intact and with no pulmonary dysfunction. We searched the medical literature to see if there were similar cases of sand and saltwater aspiration and found none.

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