Patient's chest literally catches fire during open heart surgery

Australia: Doctors at the Austin Health in Melbourne, Australia, wary of the use of electrocautery devices (using heat to stop vessels from bleeding) after a 60-year-old man suffered a flash fire in his chest cavity during emergency heart surgery. The flash fire was caused by supplemental oxygen leaking from a ruptured lung. However, the doctors were able to put out the fire and complete the surgery without any further complications.

This unique case was presented at the Euroanaesthesia Congress (the annual meeting of the European Society of Anaesthesiology) in Vienna, Austria to be held from June 1-3, 2019 by Dr. Ruth Shaylor, an anesthesiologist at Tel-Aviv Medical Center in Israel and Austin Health in Melbourne, Australia.

Although the event was unusual, it's not actually the first time this has happened to a patient. Previously, seven other case reports detailed instances where a chest cavity fire had broken out during surgery - three involving thoracic surgery, and the other four during bypass surgery.

The doctors warn that the case highlights the potential dangers of dry surgical packs in the oxygen-enrich environment of the operating theatre where electrocautery devices are used.

According to the doctors, the man presented for emergency repair of an ascending aortic dissection--a tear in the inner layer of the aorta wall in the chest. The patient had a history of chronic obstructive pulmonary disease (COPD) and had undergone coronary artery bypass grafting one year previously.

As they began operation, they noted that the lung had stuck to his sternum, which the surgeons needed to crack through to get to his heart. In spite of their best efforts, they punctured one of the bullae in the lung, and the air began leaking out.

To counteract this, the flow of oxygen in the anesthetic inhalant was increased by 100 percent. But apparently it was a big leak - the doctors were able to smell the sevoflurane anesthetic as it seeped into the air through the patient's lung. That sevoflurane was now mixed with a strong concentration of highly oxidizing oxygen, making the conditions volatile.

But fire doesn't just start out of nowhere, even when such gases are leaking out of the patient. That's where the last unlucky ingredient comes in: The team was also using an electrocautery device, a surgical tool that uses heat to seal (or cauterize) wounds.

Apparently, the device was sitting a bit too close to a dry surgical pack near the patient's chest. When a spark from the electrocautery device landed on the dry surgical pack in the highly oxygenated air, the whole thing burst into flames.

Luckily, the fire was immediately extinguished without any injury to the patient. The rest of the operation proceeded uneventfully and the repair was a success.

"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 anesthetists 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, " Dr. Shaylor advises.