A 60-year old man from Australia suffering from chronic obstructed pulmonary disease (COPD) made medical headlines when his chest cavity caught fire during emergency heart surgery.
The flash fire that erupted from the patient’s chest cavity was caused by supplemental oxygen leaking from a ruptured lung, according to a statement from the European Society of Anaesthesiology (ESA). This rare incident was presented at their annual meeting in Vienna on 2 June 2019.
As surgeons began to operate, they noticed that the right lung was stuck to the overlying sternum. The lung was destroyed in places and showed signs of overinflating, which is often caused by COPD. The surgeons tried to dissect the stuck lung, but noticed that one of the bullae (enlarged air spaces in the lung) was punctured. This caused a substantial air leak in the man’s chest cavity.
As the surgeons wanted to prevent respiratory distress in their patient, anaesthetic gases and oxygen were increased. Unfortunately, this is where it all went wrong – a spark from the electrocautery (the process used to remove the lung tissue around the sternum) set a dry surgery pack alight.
The fire was extinguished and the patient was unharmed, but this incident highlighted the significance of fire hazard in the operating room, especially in cases of COPD, the main cause of this air leak.
Lung conditions require more caution during surgery
"While there are only a few documented cases of chest cavity fires – three involving thoracic surgery and three involving coronary bypass grafting – all involved the presence of dry surgical packs, electrocautery, increased inspired oxygen concentrations, and patients with COPD or pre-existing lung disease," explained Dr Ruth Shaylor from Austin Health in Melbourne, Australia, where the incident took place.
"This case highlights the continued need for fire training and prevention strategies and quick intervention to prevent injury whenever electrocautery is used in oxygen-enriched environments.
"In particular surgeons and anaesthetists need to be aware that fires can occur in the chest cavity if a lung is damaged or there is an air leak for any reason, and that patients with COPD are at increased risk,” the statement says.
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