As if open heart surgery isn't enough of a challenge.

By Christina Oehler
Updated: June 04, 2019

Undergoing open heart surgery is a pretty big deal on its own. But one surgery patient faced an incredible and life-threatening complication while on the operating table: A fire broke out inside his chest cavity in the middle of the procedure.

The 60-year-old man, from Melbourne, Australia, went to the hospital for emergency surgery in 2018 to repair a tear in the inner layer of the wall of his aorta. The unusual case, which was presented over the weekend at the European Society of Anaesthesiology annual meeting, involved a patient with a medical history that was a bit more complicated than usual. He had a history of chronic obstructive pulmonary disease (COPD), a lung disease that contributed to this rare accident.

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So how exactly did a fire break out in his chest? Because of his COPD, the man had air pockets in his lungs called bullae. During surgery, a doctor accidentally punctured the bullae, which caused air to leak from the lung. To prevent respiratory problems during surgery, doctors had increased the amount of oxygen in the patient’s anesthesia. A surgical tool the doctors were using emitted a spark—and the combination of this and the extra oxygen caused the dry surgical pack inside the patient’s chest to catch fire.

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Incredibly, the surgical team was not only able to extinguish the fire, but the patient made it out of his surgery successfully. What might be even more amazing, however, is that this isn't the first time a surgery patient's chest caught on fire. It's known to have happened six times before.

"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,” Ruth Shaylor, MD, a doctor from Austin Health in Melbourne, where the fire took place, said in a press release from the annual meeting.

"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,” she stated. “In particular surgeons and anaesthetists 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."

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