Single-Lumen Tube Cuff Tamponade and Dynamic Positioning for Bronchoscopy-Associated Massive Airway Hemorrhage: A Case Series

Bronchoscopy-associated acute massive airway hemorrhage (BAMAH) is an uncommon, yet life-threatening emergency as rapid airway flooding can compromise bronchoscopic visualization, ventilation, oxygenation, and circulation. Conventional bronchoscopic and lung-isolation methods may be difficult to deploy when visualization is lost, whereas bronchial artery embolization and surgery cannot provide immediate airway stabilization. This brief report describes a rescue strategy guided by a simplified ABCDE framework using a cuffed single-lumen endotracheal tube, cuff tamponade, lung isolation, and dynamic positioning. We retrospectively reviewed eight patients who developed BAMAH during therapeutic rigid bronchoscopy under general anesthesia at a tertiary hospital between January 2004 and December 2021. The framework utilized airway and bleeding assessments, concurrent oxygenation, circulatory resuscitation, direct bronchoscopic control, and escalation to endotracheal rescue when visualization was lost, bronchoscopic hemostasis was no longer feasible, or when rapid physiological deterioration occurred. Depending on the bleeding site, the tube was advanced beyond a tracheal lesion or into the contralateral non-bleeding main bronchus, and the cuff was positioned to provide temporary tamponade and lung isolation. Trendelenburg positioning and lateral tilt were adjusted according to bleeding control and oxygenation. All eight patients developed severe hypoxemia during hemorrhage, and five patients experienced cardiac arrest. After intubation, immediate airway stabilization was achieved in all patients, with temporary compression hemostasis, lung isolation, and recovery of monitor-displayed peripheral oxygen saturation (SpO₂) to at least 90%. No intraoperative death occurred during the rescue procedure. Three patients subsequently underwent emergency bronchial artery embolization. Four patients died within 48 hours from disseminated intravascular coagulation and multiple organ failure. As a result, this strategy should be viewed as a practical temporizing rescue method that provides patients with time for further treatment, rather than a definitive therapy.