Fatal innominate artery hemorrhage in a patient with tetraplegia: Case report and literature review

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2017.1417802 · Published: November 1, 2018

Spinal Cord Injury Cardiovascular Science Surgery

Simple Explanation

This case report discusses a rare but fatal complication of tracheostomy, which is hemorrhage from the innominate artery due to the formation of a trachea-innominate artery fistula (TIF). This is especially concerning in patients with spinal cord injuries. The report details the case of a 15-year-old boy with tetraplegia who had a tracheostomy and later died from innominate artery hemorrhage. The patient had multiple complications, including subglottic stenosis and recurrent respiratory failure. The authors emphasize the importance of healthcare providers being aware of this rare condition, particularly in non-acute settings, and highlight the unique challenges that patients with spinal cord injuries and tracheostomies face.

Study Duration

Not specified

Participants

A 15-year-old boy with C5-level incomplete SCI

Evidence Level

Case Report and Literature Review

Key Findings

1
A 'sentinel bleed' or 'herald bleed' can be an early warning sign of a trachea-innominate artery fistula (TIF). This bleeding may be self-limiting but recurrent, and can be aggravated by coughing or aspiration.
2
Patients with spinal cord injuries (SCI) and tracheostomies may face unique respiratory challenges that can increase the risk of TIF formation. Factors like neuromuscular weakness, respiratory insufficiency, and poor neck posture can contribute.
3
Early identification and aggressive management are crucial for improving the prognosis of TIF-related hemorrhage. The most successful immediate control measure involves removing the tracheostomy tube and inserting an endotracheal tube.

Research Summary

This case report highlights a fatal case of innominate artery hemorrhage in a patient with tetraplegia and a tracheostomy, emphasizing the importance of recognizing and managing this rare but lethal complication. The discussion underscores the significance of considering patient-specific factors, such as respiratory compromise in spinal cord injury, that may predispose individuals to tracheo-innominate artery fistula (TIF) formation. The conclusion stresses the need for increased awareness among clinicians, especially in non-acute settings, regarding the warning signs of TIF and the importance of aggressive management to improve patient outcomes.

Practical Implications

Increased Awareness

Healthcare providers, especially in non-acute settings, should be educated about the risk factors, warning signs (such as sentinel bleeds), and management strategies for tracheo-innominate artery fistula (TIF).

Holistic Patient Assessment

When managing patients with tracheostomies, especially those with spinal cord injuries, clinicians should consider the individual's specific impairments and associated conditions that may contribute to TIF formation.

Prompt Intervention

In any patient with a tracheostomy and suspected TIF, a high index of suspicion should be maintained, and prompt therapeutic steps, including potential surgical intervention, should be taken to control hemorrhage and prevent fatal outcomes.

Study Limitations

1
Single case report limits generalizability
2
Lack of detailed information on specific tracheostomy tube management practices.
3
Retrospective nature of the report relies on available medical records.

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