Abstract
Innominate artery injury is a rare, but catastrophic complication of tracheostomy. We present a case of severe hemorrhagic shock in a 79-year-old male with innominate artery injury that occurred during tracheostomy. Despite temporary innominate artery isolation, the regional forehead saturation was 60 % without laterality. Because adequate cerebral blood flow was apparently maintained through collateral flow, we ligated the innominate, right carotid, and subclavian arteries. We confirmed adequate blood flow to the brain and the right subclavian artery through collateral circulation after ligation using computed tomographic angiography. A damage control management, which involves ligating the injured innominate artery to arrest hemorrhage and monitoring regional forehead saturation for brain ischemia, can be a considerable procedure for the treatment of severe hemorrhagic shock due to innominate artery injury.
Highlights
Innominate artery (IA) injury, including formation of a tracheo-innominate fistula, is a rare but severe complication of tracheostomy that is associated with high mortality due to the resultant severe hemorrhagic shock [1]
A damage control strategy consisting of prompt control of bleeding and management to maintain physiological homeostasis—crucial to avoiding the deadly triad of hypothermia, acidosis, and coagulopathy—is essential in a patient with severe hemorrhagic shock, such as following a neck vessel injury [2]
IA injury is a rare, but severe, complication of tracheostomy that is associated with high mortality due to the resultant severe hemorrhagic shock [1]
Summary
Innominate artery (IA) injury, including formation of a tracheo-innominate fistula, is a rare but severe complication of tracheostomy that is associated with high mortality due to the resultant severe hemorrhagic shock [1]. Case presentation A 79-year-old male, with terminal lung cancer at the right upper lobe, had been in another hospital and intubated for 3 weeks since an accidental airway obstruction His doctor performed the tracheostomy in a surgical manner at the bedside. Arterial blood gas assessment revealed metabolic and respiratory acidosis and anemia [pH 7.09, pCO2 71 mmHg, pO2 193 mmHg, HCO3− 21.0 mmol/L, base excess (BE) −8.3 mmol/L, lactate (Lac) 5.5 mmol/L, hemoglobin (Hb) 7.9 g/dL, hematocrit (Ht) 22 %, FiO2 1.0], and blood tests showed coagulopathy [PT 35.3 %, PT-INR 1.68, activated partial thromboplastin time (APTT) 56.2 s, fibrinogen (Fib) 84 mg/dL] These data showed that his condition was in severe hemorrhagic shock and coagulopathy. On postoperative day 7, the patient was transferred to a sub-acute, community hospital
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
