Korean J Anesthesiol.  2004 Jun;46(6):724-728. 10.4097/kjae.2004.46.6.724.

Cardiac Arrest after Complete Intratracheal Obstruction by an Aspirated Blood Clot in a Patient with Upper G-I Bleeding: A case report

• Kim DK
• Jin HY
• Oh HR

• KMID: 2299082
• DOI: http://doi.org/10.4097/kjae.2004.46.6.724

Abstract

Fatal airway obstruction due to the presence of blood clot occurs in a variety of clinical settings. Initial efforts to remove an airway clot, if warranted, involve suctioning, lavage, and forceps extraction through a flexible bronchoscope. If unsuccessful, further management options include rigid bronchoscopy, balloon-tip embolectomy catheter dislodgement, and the application of topical thrombolytic agents. We report a case of complete airway obstruction that developed after the aspiration of a blood clot during emergency operative vessel ligation in a 86-year-old female patient with gastric ulcer bleeding. Initial conventional suctioning was unsuccessful, in this case, due to a large firmly adherent clot. Therefore we peformed the alternative suctioning technique using suction attached directly to the existing tracheal tube in situ, with the cuff deflated. However, repeated direct tracheal suctioning alone failed to prevent cardiac arrest. Thereafter, simultaneously with several CPR chest compressions, large cylindrical clots were sucked up by direct tracheal suctioning. Presumably simultaneous chest compression has the potential advantage of creating higher airway pressures that provide effective kinetic energy to obstructing object.

Keyword

airway obstruction; aspiration, blood; resuscitation; suction catheter; trachea

MeSH Terms

Aged, 80 and over
Airway Obstruction
Bronchoscopes
Bronchoscopy
Cardiopulmonary Resuscitation
Catheters
Embolectomy
Emergencies
Female
Fibrinolytic Agents
Heart Arrest*
Hemorrhage*
Humans
Ligation
Resuscitation
Stomach Ulcer
Suction
Surgical Instruments
Therapeutic Irrigation
Thorax
Trachea
Fibrinolytic Agents