Single-Lumen Endotracheal Intubation Combined with Dynamic Positioning for Bronchoscopy- Associated Acute Massive Airway Hemorrhage: A Case Series Based on ABCDE protocol

BACKGROUND Bronchoscopy-associated acute massive airway hemorrhage (BAMAH) is a life-threatening emergency requiring rapid intervention. Traditional methods face challenges in emergency settings due to operational complexity and clot occlusion risks. This study evaluates a novel ABCDE protocol guided strategy integrating single-lumen endotracheal intubation with dynamic positioning. METHODS A retrospective case series analyzed 8 AMAH patients (2004–2021) managed at a tertiary hospital. The intervention combined single-lumen tube compression hemostasis (cuff-targeted mechanical tamponade) and dynamic positioning (Trendelenburg with lateral tilt). Outcomes included hemostasis success rate, oxygenation improvement, and complications. RESULTS Hypoxemia was observed in all eight patients, with six patients exhibiting a minimum oxygen saturation of 0%, while the remaining two patients had minimum oxygen saturations of 10% and 20%, respectively. The mean duration of operation was 100 minutes (range:50min-190min), and the mean blood loss volume was 2137.5 ml (range:800ml-3600ml). All patients achieved immediate hemostasis, post-intubation SpO₂ increased to ≥90%, and no mortality occurred intraoperatively. However, 50% mortality (4/8) was observed due to disseminated intravascular coagulation and multi-organ failure. CONCLUSION The ABCDE protocol (Airway-Bleeding-Circulation-Disposal-Endotracheal intubation) provides a structured framework for managing BAMAH. Single-lumen intubation with dynamic positioning achieves dual goals: rapid hemostasis via cuff compression and lung protection through gravity-assisted drainage. TRIAL REGISTRATION: not applicable.