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Catastrophic haemoptysis during rigid bronchoscopy: a discussion of treatment options to salvage patients during catastrophic haemoptysis at rigid bronchoscopy

^a Department of Thoracic Surgery, Royal Devon and Exeter Hospital, Wonford Road, Exeter, Devon EX2 5DW, UK
^b Department of Radiology, Royal Devon and Exeter Hospital, Wonford Road, Exeter, Devon EX2 5DW, UK

^* Corresponding author. Address: Royal Devon and Exeter NHS Trust, Barrack Road, Exeter, Devon EX2 5DW, UK. Tel.: +44-1392-402689; fax: +44-1392-402175
richard.berrisford{at}rdehc-tr.swest.nhs.uk

OBJECTIVE: We report a negative experience of fatal haemorrhage during rigid bronchoscopy when an intrabronchial lesion was biopsied. Despite being prepared for and carrying out emergency sternotomy and clamping the lung hilum, the patient died.

METHODS: We reviewed mainly non-surgical literature for recommendations for the management of catastrophic bleeding at bronchoscopy.

RESULTS: The literature does provide advice for management of ‘massive haemoptysis’ defined as more than 600 ml in 24 h and ‘exsanguinating haemoptysis’ which is at least 1000 ml blood loss at a rate more than 150 ml/h. However there is little in the current surgical literature on the immediate treatment of ‘catastrophic haemoptysis’ which we define as major bleeding from the airway causing an immediate threat to life requiring immediate surgery. Gathering treatment options from various authors we present a suggested protocol for the management of this thoracic surgical emergency.

CONCLUSIONS: We recommend the initial salvage treatment to be: (1) wedge the rigid bronchoscope into the haemorrhaging bronchus, (2) tamponade the bleeding site with a balloon-tipped vascular catheter, (3) remove the bronchoscope and intubate with a double-lumen tube, (4) undertake emergency definitive surgery. We strongly recommend that a suitable catheter be kept immediately available for this very rare but dangerous complication.

Key Words: Haemoptysis; Bronchoscopy; Massive; Catastrophic; Balloon