Complicated extubation in a patient with an obstructing tracheobronchial thrombus

Authors

Milan Terzic, Trinity Health Ann ArborFollow
Daniel Aintabi, Trinity Health Ann ArborFollow
Omar Hegazy, Trinity Health Ann ArborFollow

Document Type

Case Report

Disciplines

Higher Education | Medicine and Health Sciences

Abstract

Endotracheal intubation is an effective and rapid technique used as a standard practice for airway management. Airway injury or complications could be a significant cause of morbidity and mortality for patients. Tracheobronchial obstruction secondary to thrombus formation are life threatening complications of traumatic intubations. We present a case of complicated extubation resulting in cardiac arrest in a patient with an obstructing tracheobronchial thrombus. The patient, an 83-year-old female, with atrial fibrillation presented for neck pain. During CT imaging, she developed ventricular fibrillation cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after three cycles of compressions and defibrillation and the patient was intubated. After stabilization of the patient and passing of spontaneous breathing trials, the patient was extubated. The patient rapidly developed hypoxic respiratory failure and progressed to pulseless electrical activity. ROSC was achieved again after 3 rounds of compressions. The following days, after passing her SBT yet again, extubation was attempted. She had an audible stridor and visible respiratory distress. Bedside Yankauer suction of the oropharynx resulted in retrieval of a large 6x2cm thrombus. Immediate resolution of stridor and improved oxygenation occurred. Tracheobronchial clots are a cause of cardiac arrest and potentially fatal cause of endotracheal intubation. Physicians and respiratory therapists must be aware of optimizing pre-extubation conditions in the setting of TB obstruction as it can lead to arrest and death.

DOI

https://doi.org/10.32873/unmc.dc.gmerj.5.2.004

Keywords

Endotracheal tube, clot, cardiac arrest, extubation, tracheal thrombus

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Recommended Citation

Terzic, M., Aintabi, D., , Hegazy, O. Complicated extubation in a patient with an obstructing tracheobronchial thrombus. Graduate Medical Education Research Journal. 2023 Nov 30; 5(2).
https://digitalcommons.unmc.edu/gmerj/vol5/iss2/7