Cardiac Arrest After Inhalation of Hazardous Gas Suspected Hydrogen Sulfide at Cucumber Pickle Factory: Two Case Reports.

We report two cases of acute occupational exposure to hazardous gas, suspected to be hydrogen sulfide. The 34-year-old male and 48-year-old female patients worked as cleaners at a pickled cucumber factory. The two victims cleaned a waste tank (containing organic waste that can produce hydrogen sulfide) that had been abandoned for 2 years, with a volume of about 8 cubic meters. After 1 min of going down the tank, the female victim smelled a strong, foul odor and then became dizzy and fainted. After hearing the sound of the patient fainting, the second victim who went down to save her also fainted shortly after. The two victims were brought up; they both suffered a cardiac arrest. Co-workers performed cardiopulmonary resuscitation (CPR), and return of spontaneous circulation (ROSC) was achieved 5-7 min after the collapse. They were sent to the local hospital and immediately intubated. They experienced hypotension and were treated with epinephrine and were transferred to our department. The female patient was still comatose (Glasgow Coma Scale 6 [E 1, V 1, M 4]) upon arrival at our department 3.5 h after ROSC. She was administered extravascular temperature control with a target temperature of 33°C within 24 h. We rewarmed her at a rate of 0.25°C/h to 37°C within 16 h. The two patients were then extubated after 3 days of treatment and discharged after 14 days of treatment without neurological complications. The patients were scheduled for a follow-up examination in 3 months. The two victims described what they smelled as rotten eggs. The available clinical evidence suggests that they were exposed to hydrogen sulfide.