Carbon Monoxide Poisoning Due to “Mud Bogging”

N Engl J Med 2015; 373:1082September 10, 2015DOI: 10.1056/NEJMc1507473

Article

To the Editor:

“Mud bogging” is an off-road motorsport in which drivers navigate vehicles over a muddy pit or track. Immobilization of these vehicles occurs frequently and may cause exhaust pipes to become clogged with mud. Subsequent permeation of carbon monoxide throughout the cabin places occupants at risk for serious toxic effects. The hazards of mud bogging were recently highlighted by the death of Shain Gandee, a cast member of the MTV series Buckwild.1 We report two incidents, each affecting two people, in which serious carbon monoxide poisoning occurred as a result of mud bogging.

In the first incident, an 18-year-old male driver and a 16-year-old female passenger were transferred to a tertiary referral center after losing consciousness while mud bogging. On arrival at the emergency department, their carboxyhemoglobin levels were 18.5% and 14.0%, respectively. Both were given 90-minute sessions of treatment with hyperbaric oxygen consisting of the administration of pure oxygen at 2.8 atm for 30 minutes, followed directly by 2.0 atm of pure oxygen for an additional 60 minutes. Both patients declined further therapy. (The intended protocol involves three sessions. First, hyperbaric oxygen is administered at 2.8 atm for 30 minutes, followed directly by 2.0 atm for 60 minutes. Patients are then given a 360-minute break. In the second and third sessions, patients receive 2.0 atm of hyperbaric oxygen for 90 minutes, with a 360-minute break between sessions.)

In the second incident, two male patients, 16 and 19 years of age, were transferred to a tertiary referral center after losing consciousness in the backseat of a vehicle during mud bogging. The 16-year-old patient, who had diabetes mellitus, received cardiopulmonary resuscitation for “weak pulses” and bradycardia. He quickly regained consciousness but remained “lethargic” and reported having blurred vision. The 19-year-old patient, who was healthy, was also lethargic and reported complete vision loss. Their carboxyhemoglobin levels were 39.6% and 47.5%, respectively. Both patients completed all three treatment sessions described in the protocol. Complete resolution of all symptoms ensued.

Mud bogging may place participants at risk for carbon monoxide poisoning. Clinicians should increase their suspicion of carbon monoxide poisoning when assessing patients with otherwise unexplained symptoms who have recently participated in this activity. Although there are no available supportive data, it is reasonable to expect that maximizing ventilation in the passenger cabin by keeping windows open at all times and using portable carbon monoxide detectors may reduce exposure and prevent toxic effects.