There’s a reason heart surgeons get paid $287,000 a year. Their jobs are stressful; the stakes are high. When you’re in the operating theatre and someone's life is in your hands, things can get… heated.
Imagine doing open-heart surgery on a person, for example, when their chest cavity suddenly and inexplicably bursts into flames. Imagine it. Would you know what to do in that situation? I would not. I would absolutely not know what to do in a situation where I’m trying to perform a life-saving procedure on a person’s heart and their chest catches fire.
This happened at a hospital in Melbourne last year. Dr Ruth Shaylor and colleagues from Austin Health—where the incident took place—appeared at the Euroanaesthesia Congress in Vienna over the weekend to present the case of a 60-year-old man who suffered a flash fire in his chest cavity during emergency heart surgery.
The man reportedly required an emergency repair of an ascending aortic dissection—that is, a tear in the inner layer of the aorta wall in the chest. When surgeons cracked open his sternum and began to operate, however, they noticed that the patient’s right lung was stuck to the overlying sternum: an issue caused by several inflated, air-filled blisters on the man’s lung tissue—growths commonly associated with Chronic Obstructive Pulmonary Disease (COPD).
Surgeons attempted to unstick the lung tissue from the sternum, but in so doing accidentally punctured one of the blisters and caused a “substantial air leak” out of the lung. Then, in order to prevent the patient from going into respiratory distress, the doctors increased the flow of anaesthetic gases to 10 litres per minute, and the proportion of oxygen to 100 percent.
Let’s take a moment to quickly review the factors at play here. There’s pure oxygen all over the place at this point—including some that’s leaking out through a hole in the patient’s ruptured lung. And doctors are using a device known as an electrocautery, which uses heat to burn or cut through tissue, to carry out the operation. As far as fire danger ratings go, it’s nigh on catastrophic.
Shortly after the patient’s air was changed, a spark from the electrocautery ignited the surgical pack—a kit used to carry sterilised surgical instruments, located near the man’s open chest cavity—and his chest cavity went up in flames. The doctors reported that the fire was immediately extinguished without any injury to the patient, and “the rest of the operation proceeded uneventfully.” Overall, they claim, the repair was a success.
When addressing the Euroanaesthesia Congress, however, Dr Shaylor reflected candidly on the dangerous conditions that ultimately led to the chest cavity fire—and called for more fire training within the operating theatre to prevent such incidents from causing serious harm in the future.
"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," she noted. "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,” she added, “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."
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