Emergency treatment of acute massive hemorrhage during transbronchial lung biopsy outside operating room

Rationale: Massive hemorrhage related to bronchoscopy procedures can occur suddenly, with rapid bleeding and difficulty in hemostasis, potentially leading to airway obstruction, asphyxiation, and even shock or death. The management of acute massive hemorrhage during transbronchial lung biopsy procedures is particularly critical. Patient concerns: This case report describes a patient with a complex condition who experienced massive bleeding during a fiberoptic bronchoscopy lung biopsy. Diagnoses: The patient had a complex medical history, including community-acquired pneumonia (common type), emphysema, pulmonary nodule, postradiation therapy for breast cancer, post-PCI for coronary atherosclerotic heart disease, grade 3 hypertension (extremely high risk), and atrial fibrillation (arrhythmia). Interventions: Preoperative bleeding risk assessment and preventive measures were performed. During the emergency, rescue procedures included airway control via large-diameter endotracheal intubation, body position adjustment, drainage and suction, systemic and local hemostasis, fluid therapy, maintenance of a normal internal environment, and stabilization of vital signs. Outcomes: The operation was successfully completed. After the operation, the patient improved with hemostatic treatment and care and was discharged smoothly. Lessons: Controlling the airway to ensure ventilation is crucial during massive bleeding related to bronchoscopy procedures. Intubating a large-diameter endotracheal tube into the main airway can improve ventilation and provide time and opportunity for subsequent hemostatic measures. The rescue process requires close cooperation among the medical team and the use of various treatment measures, including adjusting body position, drainage and suction, intubation, systemic and local hemostasis, fluid therapy, maintaining a normal internal environment, and stabilizing vital signs, to ensure the patient transitions from danger to safety. Additionally, preoperative identification of high-risk patients and preventive and emergency strategies are also of significant importance in preventing massive bleeding during bronchoscopic biopsy. However, this is a single-case experience, and its safety and general applicability require further validation through larger studies.