Australian doctors recently described an unusual incident during a patient’s heart surgery, to determine if others had encountered anything similar. It was presented to the Euroanaesthesia Congress, a convention held annually by the European Society of Anesthesiology.
The story began with a 60-year-old COPD (chronic obstructive pulmonary disease) patient who had experienced an aortic dissection. This is a tear in the inner wall of the main artery pumping blood away from the heart and is potentially fatal. The patient required emergency surgery to repair the tear to the passage. Although the surgeons were mindful that the patient’s COPD could create complications, they were not prepared for the situation they were about to experience.
COPD patients often have air-filled blisters on their lungs called bullae. Because it was necessary to break the patient’s sternum open to gain access to the heart, the physicians were prepared to accomplish this very carefully. After opening the chest, surgeons discovered that the bullae had caused the right lung to attach to the sternum. The doctors carefully began to pull the lung from the sternum, but one of the bullae were punctured causing an air leak. To avoid respiratory distress, the oxygen level flowing through the patient’s ventilator tube was increased to 100 percent and more anesthesia was deemed necessary.
Later in the surgery, an electrocautery device was needed to burn or cut through tissue. A spark from the electrocautery device landed on a nearby package used to carry surgical instruments after sterilization. With a heavy presence of oxygen in the air, a flash fire was produced in the patient’s chest cavity. Fortunately, the fire was quickly extinguished without causing damage to the patient. Doctors were able to continue with the surgery, ultimately repairing the artery.
Surprisingly, six other cases of chest fires during open heart surgery had been documented. All the cases were under similar circumstances including high levels of oxygen, electrocautery devices, and patients who had previously suffered lung damage. Though these instances are rare, the doctors wish to make others aware of the hazard. Preventive measures should be taken to avoid future occurrences of chest fires. A plan of action should also be in place to extinguish fires if the need arises.