Tracheo-carotid artery erosion following endotracheal intubation

A case of tracheo-carotid artery erosion in a patient who required only endotracheal intubation is presented. This appears to be the first case reported in the world literature that was not associated with a tracheostomy. Etiologic factors leading to this complication include direct pressure from the tube tip, abrasions during intubation, mucosal damage from cuffs, and CPAP, even over a short time. Selection of an endotracheal tube with a high-compliance, low-pressure cuff, careful intracuff pressure monitoring, prevention of infection and hypotension, and improvement in the patient's nutritional and immunologic status will help to prevent this complication. Any patient bleeding more than 10 ml without cause should be suspected of having this complication. Rapid treatment is necessary for survival. Patients should be intubated and the cuff inflated. Bronchoscopic examination should be done in the operating room under general anesthesia with neck and chest prepped and draped. Median sternotomy or possibly right anterior thoracotomy is recommended. Resection of involved vessels has been successful.