Massive Early Post-Tracheostomy Hemorrhage From Inferior Thyroid Artery Branch Injury: An Oxygenation-Preserving Airway Rescue Strategy.

Early life-threatening hemorrhage following tracheostomy is uncommon and may arise from injury to branches of the inferior thyroid artery. Early recognition is critical because ongoing hemorrhage may rapidly flood and obscure the airway, compromise oxygenation, and make definitive airway management extremely challenging. We report a 70-year-old male with recent ischemic stroke who underwent tracheostomy and percutaneous endoscopic gastrostomy placement and developed massive bleeding from the tracheostomy stoma approximately 26 hours after the tracheostomy placement. During emergent airway management, temporary digital compression was applied to control hemorrhage while ventilation was maintained through the existing tracheostomy tube as oral endotracheal intubation was attempted using video laryngoscopy. After definitive endotracheal tube placement was confirmed, surgical exploration revealed hemorrhage from inferior thyroid artery branches requiring ligation and tracheostomy revision. This case highlights the importance of rapid recognition of early surgical-site arterial bleeding, preservation of oxygenation during airway rescue, and coordinated surgical hemorrhage control.