Giving new meaning to heartburn

An Australian man’s chest literally caught on fire during emergency heart surgery after a dry surgical pack ignited in a high-oxygen environment.

The 60-year-old patient was undergoing surgery for a tear in the inner wall of the aorta, the main blood vessel leaving the heart, when doctors needed to increase the flow of oxygen in his anaesthetic to 100%.

Soon after, a spark from the electrocautery device — a heated electrode used to stop bleeding — ignited a dry surgical pack. Fortunately the fire was immediately extinguished without any injury to the patient; the rest of the operation proceeded uneventfully and the repair was a success.

Dr Ruth Shaylor and colleagues from Austin Health in Melbourne, where the incident took place, warn that the case highlights the potential dangers of dry surgical packs in the oxygen-enriched environment of the operating theatre where electrocautery devices are used.

“While there are only a few documented cases of chest cavity fires — three involving thoracic surgery and three involving coronary bypass grafting — all have involved the presence of dry surgical packs, electrocautery, increased inspired oxygen concentrations, and patients with COPD or pre-existing lung disease,” explained Dr Shaylor.

“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 if there is an air leak for any reason, and that patients with COPD are at increased risk.”

The unusual case was presented at the Euroanaesthesia Congress (the annual meeting of the European Society of Anaesthesiology).

The following key learnings were identified:

• Chest cavity fires, though rare, can occur in the presence of high inspired oxygen, electrocautery, and dry surgical packs.
• Patients with underlying lung disease and an airway leak are at increased risk.
• Care should be taken by the anaesthetic team to use the minimum inspired oxygen concentration possible in these cases.
• It is the responsibility of the entire surgical team to be aware of this potential risk and ensure surgical packs are damp prior to placing them in the surgical field.

Image credit: ©stock.adobe.com/au/ Konstantin Yuganov