In August 2018, a 60-year-old man went into surgery for the emergency repair of an ascending aortic dissection--a tear in the inner layer of the aorta wall in the chest. The patient had a history of chronic obstructive pulmonary disease (COPD) and had undergone coronary artery bypass grafting one year previously. What transpired next, baffled everyone.

While the doctors we're doing open-heart surgery on the person, his chest cavity suddenly and inexplicably bursts into flames.

This happened at a hospital in Melbourne last year. Dr Ruth Shaylor and colleagues from Austin Health—where the incident took place—recently appeared at the Euroanaesthesia Congress in Vienna to present the case of the 60-year-old who suffered flash fire in his chest cavity during emergency heart surgery. The doctors warned that the case highlights the potential dangers of dry surgical packs in the oxygen-enrich environment of the operating theatre where electrocautery devices (using heat to stop vessels from bleeding) are used.

According to the doctors, as surgeons began operating they nlted that the man's right lung was stuck to the overlying sternum with areas of overinflated and destroyed lung. During surgery one of these bullae was punctured causing a substantial air leak. Subsequently, the flows of anaesthetic gases were increased to 10 litres per minute and the proportion of oxygen to 100 per cent, to prevent respiratory distress.

However, a spark from the electrocautery device ignited a dry surgical pack, located near the man’s open chest cavity—and his chest cavity went up in flames.

Thankfully, the fire was immediately extinguished without any injury to the patient and the rest of the operation proceeded uneventfully and the repair was a success.

Speaking about the incident, Dr Shaylor explained, "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."

The doctor further added that the 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 said, "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."