Perioperative Management of Carotid Blowout Syndrome After Head and Neck Cancer Treatment: A Retrospective Case Series.

Abstract

Background: Carotid blowout syndrome (CBS) is a life-threatening emergency involving the rupture of the carotid arteries and/or branches, often following surgery and radiotherapy for head and neck cancer. Our case series aimed to describe airway management strategies, endovascular and surgical approaches, perioperative resuscitation management, and clinical outcomes in a cohort of patients with CBS at a tertiary referral academic health center.

Methods: We retrospectively identified patients presenting with CBS between 2017 and 2021. Airway management, procedural treatment techniques, perioperative management, and clinical outcomes were extracted from the chart for each CBS occurrence.

Results: We identified 76 total cases among 62 patients (n=20 [26.3%] female; median age: 61.5 [IQR: 56 to 67]). Three cases were type I (threatened), 18 were type II (impending), 53 were type III (active bleed), and 2 were undeterminable. The most common airway management strategies were a pre-existing airway (n=37 [48.7%]), oral awake bronchoscopic intubation (n=14 [18.4%] occurrences), or nasal awake bronchoscopic intubation (n=8 [10.5%] occurrences). Resuscitation per case included intravenous crystalloid (mean: 1484 mL, SD: 791 mL), red blood cells (mean: 272 mL, SD: 906 mL), fresh frozen plasma (mean: 49 mL, SD: 400 mL), and platelets (mean: 11 mL, SD: 94 mL). Perioperative mortality was 16.1%. Thirty-nine patients (62.9%) died by the time of review (median: 157 mo, IQR: 92 to 205 mo).

Conclusions: Perioperative management of CBS is challenging, particularly airway management, in which awake bronchoscopic intubation was common. Endovascular interventions were commonly performed. The investigation highlights the importance of advanced airway management strategies for patients with CBS.