Man’s Chest Ignites during Open-Heart Surgery : The Hearty Soul

This article was originally published June 20, 2019 and has since been updated.

There is so much to worry about before going in for surgery, and very few people would think to worry about their bodies catching fire.

First of all, surgical fires are rare, but they can and do happen. Dr. Ruth Shaylor of Austin Health in Melbourne, Australia is advocating for surgeons and surgical operatives to exercise more caution while handling flammable and ignitable materials in the operating room. Shaylor and her team used the story of an Australian patient as their case study to present at the European Society of Anaesthesiology’s annual conference [1].

Aortic Repair Gone Wrong

An emergency procedure was performed on a 60-year-old male patient with COPD who had a small tear in his aorta, which was suspected to be from the coronary artery bypass grafting he had the previous year. The patient was placed under inhaled and intravenous anesthesia.

During the surgery, complications arose when it was found that his right lung was enlarged and filled with several bullae (dilated air pockets in the lungs), a complication from his COPD. His lung was stuck to his sternum, which is the breast bone that covers the heart. The doctors tried to separate the lung from the sternum,  but this resulted in the puncturing of one of the bullae. Air began to leak out rapidly leak out of his lungs and in order to balance the outward flow, they turned up the oxygen (O2) supply to the patient’s lungs.

The doctors were using an electrocautery device  to cauterize, or seal, the man’s wounds during the procedure. A spark from the device ignited a “dry surgical pack” — a bundle of sterilized equipment for the surgery, causing a “flash fire” in the man’s chest cavity. The doctors and their assistants swung into quick action and the fire was put out immediately. They reported that the patient was uninjured and the rest of the aortic repair procedure was completed successfully.

Understandably, tensions are always high in an operating room, but everyone in the room needs to be careful, work together efficiently to prevent fires like these.

Causes and prevalence of surgical fires

Surgical fires may be rare but not completely impossible. The simultaneous exposure of these three elements in the surgical room (or anywhere) is enough to cause a fire, this is known as The Fire Triangle. They are:

1. Oxidizing Agent – Oxygen, controlled by the anesthesiologist. Which in this case, led to a higher than normal oxygen environment.
2. Heat (often from a cauterizer), controlled by the surgeon.
3. Fuel (such as the “dry surgical pack”), controlled by the nurses and surgical assistants.

If these 3 variables come together in the right environment, a fire is highly likely. Oxygen, while not combustible or flammable its self can greatly accelerate how quickly a fire burns and spreads. Sources of oxygen can range from the air we breath (21% O2) to other oxygen-containing chemicals, and of course, pure O2 like the type used hospitals.

In 1999, a report named, “To err is human” was published by the Institute of Medicine which estimated that about 98,000 patients die every year due to hospital mistakes in the United States [2]. A surgical fire is a type of hospital error and it accounts for a small percentage of the total number in the US.

According to the Council of Surgical Perioperative Safety (CSPS), 550 to 650 surgical fires occur in the United States per year.  Many of the fires are dealt with and cause no harm. However, they can also result in minor to serious injuries, disfigurement, and even death [3].

“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,” said Dr. Shaylor in a press release.

An analysis by the Emergency Response Center International (ERCI) states that 68% of surgical fires are ignited by electrosurgical equipment and 13% by laser equipment [4].

A report stated by the Canadian Medical Protective Association recorded 54 cases of surgical fires occurring between 2012 and 2016, 15% of which left the patients seriously harmed [5]. Others were either traumatized or left with minor injuries and disfigurements.

Surgical fires shouldn’t be a thing

Kay Van Wey, a Board Certified Personal Injury Lawyer advises surgical operatives to be extra-careful with ignitable elements during surgery [2].

“I once handled a tragic surgical fire case where my client’s son was scheduled to undergo a minor surgical procedure to remove his tonsils,” she said. “The doctor explained that there was a complication in the operating room and that her son had been badly burned. He had been sedated and was being sent to a special burn hospital for emergency treatment due to facial and inhalation burns he suffered as a result of a surgical fire. How can this happen? How does a simple tonsillectomy operation turn into a child fighting for his life?”

Dr. Shaylor further called for the training of all surgical operatives in fire prevention, management, and control techniques. Fires can put fragile patients at risk of permanent damage, one of which includes damaging the airways of patients in open-heart surgeries.

“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,” said Dr. Shaylor. “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.”