Carotid blowout with ‘can’t intubate, can’t oxygenate’ crisis: Supraglottic surgical airway rescue

We describe an out-of-theatre hypoxic cardiac arrest precipitated by spontaneous carotid blowout syndrome, resulting in massive haemorrhage with airway contamination and a 'can't intubate, can't oxygenate' crisis. Emergency front-of-neck access (eFONA) using a scalpel-bougie technique unintentionally traversed the thyrohyoid membrane; however, this fortuitously enabled effective oxygenation and return of spontaneous circulation. Ongoing oropharyngeal haemorrhage was stabilised with packing and haemostatic resuscitation prior to definitive endovascular repair of an internal carotid pseudoaneurysm. This case demonstrates that an unintended thyrohyoidotomy, although not recommended, may function as a viable eFONA route in extremis, and highlights that temporary packing should be considered as part of a multidisciplinary approach to the management of major airway bleeding.