Venoarterial Extracorporeal Membrane Oxygenation-Assisted Whole-Lung Lavage for Near Drowning With Massive Sand Aspiration: A Case Report

Sand aspiration during drowning can cause tracheobronchial obstruction and severe respiratory failure. In life-threatening hypoxemia, there is currently no established method for the safe removal of aspirated sand. We report a case of a 50-year-old man with hypertension and angina pectoris who nearly drowned while surfing. Upon arrival at the hospital, he was unconscious, hypoxemic, and hypothermic. Chest computed tomography revealed extensive bilateral dorsal infiltrates and high-density material within the bronchi. Despite repeated suctioning of the foul-smelling sand, the partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO₂) (P/F) ratio remained less than 100 even with an FiO₂ of 1.0, necessitating whole-lung lavage (WLL). Transthoracic echocardiography (TTE) revealed severely impaired cardiac function. Because of the risk of cardiac arrest, WLL was initiated under venoarterial extracorporeal membrane oxygenation (VA-ECMO). Shortly after WLL began, the patient developed bradycardia and cardiac arrest but returned to spontaneous circulation within minutes. WLL successfully cleared the aspirated sand. His pneumonia improved, and he regained the ability to communicate. On day 49 of hospitalization, the patient was transferred for rehabilitation. Although extensive WLL is generally avoided in sand aspiration, it may be warranted in cases of severe hypoxemia caused by widespread particulate aspiration. In patients with impaired cardiac function, performing WLL under VA-ECMO support may represent a safer approach.