Exceptional survival of an airplane stowaway, treated successfully with hyperbaric oxygen

Survival of airplane stowaways is rare. Here we report an exceptional case of successful treatment and full recovery. After a transcontinental flight an unconscious stowawaywas discovered in awheelwell of a Boeing 747-400F. Airport paramedics confirmed regular respiration and achieved 100% oxygen saturation (pulse oximetry) by high-flow oxygen. Rectal body temperaturewas 35.5 degrees C. On arrival at the emergency department, the patient's vital signswere stable. He did not respond to verbal stimuli. He localized to painful stimuli with both arms, however, there was no reaction to stimuli to both legs. We suspected his neurological deficits were caused by posthypoxic encephalopathy or altitude decompression sickness (DCS), the latter amenable to hyperbaric oxygen therapy (HBOT). HBOTwas performed for 5 h (US Navy Treatment Table 6) and afterwards, full neurological recoverywas documented. About 24 h after admission a new proximal paresis of the left legwas noted. Assuming recurrence of DCS, daily HBOTwas scheduled for three days, after which motor function had again returned to normal. Stowaways travelling in airplane wheel wells experience extreme environmental circumstances. The presented patient survived an eight-hour exposure to calculated barometric pressures as low as 190 mmHg and ambient PO2 of 40 mmHg. Apart from creating awareness of this rare patient category, we want to stress the risk of altitude DCS in unpressurized flights. When DCS is suspected, immediate high-flow oxygen therapy should be initiated, followed by HBOT at the earliest opportunity. (c) 2022 The Authors. Published by Elsevier Inc.

Automated summary

We report a rare case of a successful treatment and full recovery of a stowaway found in the wheelwell of an airplane. The stowaway experienced neurological deficits due to hypoxia or altitude decompression sickness, but was treated with hyperbaric oxygen therapy and achieved complete neurological recovery.