Successful emergency management of a bleeding tracheoinnominate fistula

Abstract

In this case, we describe a novel approach to achieving temporary haemostasis in acute massive haemorrhage from a bleeding tracheoinnominate fistula. We report the case of a 42-year-old man admitted to hospital after suffering 80% body surface area burns. Thirty days following the percutaneous insertion of a tracheostomy, spontaneous massive haemorrhage occurred via the tracheostomy stoma, the tracheostomy tube and the mouth. After hyperinflation of the tracheostomy cuff which controlled airway contamination, effective tamponade was achieved using a hyperinflated balloon on a Foley catheter that was introduced by direct laryngoscopy into the upper larynx above the tracheotomy stoma. This provided temporary control of the bleeding until definitive management through ligation of the innominate artery via median sternotomy.

Keywords: adult intensive care; intensive care.

Figure 1

Comparison of three tracheostomy devices used in this case. The Portex Uniperc adjustable flange tracheostomy (A) is made of a soft reinforced tube, and does not have a rigid curve as seen in the Tracoe twist (B) or Shiley (C) dual cannula devices.

Figure 2

Digital compression of the bleeding innominate artery against the posterior sternum as described by Utley (1972). Reproduced with permission of Elsevier from Ailawadi.