Blood Filling ETT/Supraglottic Airway

[Diptherious]

I remember back when I was a student we went to a call for a 90 year old female VSA. We ran a standard medical cardiac arrest and my preceptor intubated her. Several minutes after doing so I noticed blood began filling up the ETT quite quickly, and despite constant suctioning it kept filling up. I thought this was because of airway trauma caused by poor intubation, but recently I went to a call where a King LT had been placed but the same thing was happening. I suppose it could be airway trauma as well but it seems less likely an occurence to me in the later case. I was just wondering if it's strictly poor airway insertion that causes this or some other pathological process during a cardiac arrest. I consulted google and the search function here and couldn't find a decent answer.

 

[ffemt8978]

Esophageal varices could cause it.

 

[AUSEMT]

I remember back when I was a student we went to a call for a 90 year old female VSA. We ran a standard medical cardiac arrest and my preceptor intubated her. Several minutes after doing so I noticed blood began filling up the ETT quite quickly, and despite constant suctioning it kept filling up. I thought this was because of airway trauma caused by poor intubation, but recently I went to a call where a King LT had been placed but the same thing was happening. I suppose it could be airway trauma as well but it seems less likely an occurence to me in the later case. I was just wondering if it's strictly poor airway insertion that causes this or some other pathological process during a cardiac arrest. I consulted google and the search function here and couldn't find a decent answer.

many possibilities,
try looking at disseminating intravascular coagulopathy 'DIC' it sucks and basically means end game if it progresses far enough to mean blood in the tube.
or pulmonary contusion, massive airway trauma.etc

 

[VFlutter]

Esophageal varices could cause it.

+1 E. Varices bleed like crazy. If it was a copious amount of blood I doubt it would be from airway trauma from intubation. Did you get any medical history?

 

[Diptherious]

+1 E. Varices bleed like crazy. If it was a copious amount of blood I doubt it would be from airway trauma from intubation. Did you get any medical history?

The first case was a possiblity as she had extensive medical history (
can't recall it all, happened a couple years ago). The second cardiac arrest where the King LT was placed the only history was COPD and hypertension. So what you guys are saying is the intubation itself causes the varices to rupture?

 

[FLdoc2011]

Like was mentioned above there are many causes.... DIC, underlying coagulopathy (she on blood thinners?), airway trauma, PE, diffuse alveolar hemorrhage, CHF, etc....

Varices is a cause of GI bleeding, if the ET tube is in the trachea then variceal bleeding shouldn't really bleed into the tube as the bleeding is from the esophagus.... unless your not in the trachea or using a dual lumen tube of course.

So really no way tell. Could have been an elderly person on blood thinners and a little airway trauma just kept bleeding, or could've been any number of other causes.

 

[Diptherious]

Alright this all makes sense, thanks for the input

 

[Aidey]

Varices is a cause of GI bleeding, if the ET tube is in the trachea then variceal bleeding shouldn't really bleed into the tube as the bleeding is from the esophagus.... unless your not in the trachea or using a dual lumen tube of course.

Couldn't aspiration of the blood from the varicies cause blood to come up the ET tube? Also, if the ET tube isn't sealing well couldn't you get esophageal blood in the trachea, and thus into the ET tube?

 

[abckidsmom]

And sometimes, despite proper management, the airway goes bloody. I've even seen if from CPR rib fractures.

 

[FLdoc2011]

Couldn't aspiration of the blood from the varicies cause blood to come up the ET tube? Also, if the ET tube isn't sealing well couldn't you get esophageal blood in the trachea, and thus into the ET tube?

Definitely possible, wouldn't be the first thing on my list of blood in an ET tube in a 90yr old though if no there was no hematemesis prior to intubation.

 

[MSDeltaFlt]

Regardless of which, if the airway placement was good technique, then the most likely reason for blood in the airway would be the cause of the arrest in the first place.