Because patients with this degree of airflow obstruction tolerate airway instrumentation poorly, bronchoscopy in such individuals carries a recognized risk of bleeding, low oxygen levels and cardiovascular collapse. The emergency began immediately after the team took a mucosal biopsy during the procedure. The patient developed massive endobronchial bleeding of approximately 300 milliliters, a volume large enough to flood the airway.

The nursing response, which the authors analyze through the lens of Crisis Resource Management, centered on rapid situational awareness. The team coordinated emergency tracheal intubation to secure the airway, cleared blood from the breathing passages and supported localized hemostasis using epinephrine irrigation applied to the bleeding site. Advanced life support continued for six minutes before return of spontaneous circulation was achieved, restoring a pulse and perfusion.

Once circulation returned, care shifted to post-arrest stabilization. Particular attention was paid to endotracheal tube cuff pressure, which was titrated and maintained between 25 and 30 centimeters of water. The third phase the authors describe is secondary prevention during recovery.

The patient's cardiovascular comorbidities created a difficult balancing act: anticoagulation may be necessary for cardiac protection, but blood thinning raises the risk of recurrent pulmonary hemorrhage after a major airway bleed. The report describes how the team managed this tension dynamically as the patient moved through the recovery phase, adjusting interventions according to his hemodynamic status and bleeding risk. From this single case, the authors propose a nine-phase nursing decision-making framework for high-risk bronchoscopy in elderly patients with acute exacerbations of COPD.

The framework spans preoperative risk stratification, intraoperative crisis management and post-resuscitation intensive care, emphasizing nursing-led situational awareness, structured crisis response and continuous titration of hemodynamic and ventilatory parameters rather than fixed protocols applied without adjustment. The report also includes a comprehensive geriatric assessment, complete resuscitation parameters and a comparative discussion with the existing literature on bronchoscopy-related airway hemorrhage. As a case study, the report describes the experience of one patient and cannot establish how often such events occur or how reliably the proposed framework improves outcomes.

Subject of Research: Critical care nursing management of massive airway hemorrhage and cardiac arrest during bronchoscopy in an elderly COPD patient

Article Title: Navigating catastrophic airway hemorrhage and cardiac arrest during bronchoscopy in an octogenarian with AECOPD: a critical care nursing case study

Article References: Wang, F., Tong, H., Gao, L., & Zhang, G. (2026). Navigating catastrophic airway hemorrhage and cardiac arrest during bronchoscopy in an octogenarian with AECOPD: a critical care nursing case study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08568-3

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08568-3

Keywords: bronchoscopy, airway hemorrhage, cardiac arrest, AECOPD, critical care nursing, pulseless electrical activity, resuscitation, lung-protective ventilation, case report, geriatrics, Crisis Resource Management, epinephrine irrigation