Tracheoinnominate fistula (TIF) is a rare but potentially life-threatening complication after tracheostomy. TIF was mostly observed within 7–21 days after tracheostomy but can present even years after tracheostomy. The risk factors for TIF are high cuff pressure, mucosal trauma from malpositioned cannula tip, low tracheal incision, excessive neck movement (hyperextension), radiotherapy, prolonged intubation, and high-riding innominate artery (HRIA). HRIA is also a rare anatomical variation of the innominate artery (IA) whereas IA bifurcates above the sternoclavicular joint. We report a rare case of TIF in a patient with HRIA, who presented with airway bleeding 2 months after percutaneous tracheostomy (PT) and was successfully managed with aggressive resuscitation and midline sternotomy. Knowledge of anatomical variation of the aortic arch and its major branches is essential for the physician who is routinely performing or managing tracheostomy. All the health-care workers involved in the management of tracheostomy should bear this complication in mind while dealing with any airway bleed. We recommend the routine use of bedside neck ultrasonography before all PTs to locate any aberrant vessel within the vicinity of tracheostoma to prevent this complication.

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Background: Cardiac arrest (CA) is a sudden collapse of cardiac mechanical function as evidenced by the absence of detectable pulse and the absence or gasping of breath, which all combined with a loss of consciousness. Although researches on resuscitation efforts have been increasing significantly recently, little investigations have been done on the incidence of unexpected CA among intensive care unit (ICU) patients, in particular, in Saudi Arabia. Aim: The main goal of this research is to explore the rate and patient characteristics of unexpected CA among in ICU patients in the National Guard Health Affairs hospitals in Jeddah, Riyadh, and Al Ahsa. Materials and Methods: This study was a retrospective analysis of ICU patients who experienced unexpected CA. Settings: The study was conducted at the ICUs of three National Guard hospitals in Saudi Arabia. Results: Findings showed that only 11% of the ICU patients who received cardiopulmonary resuscitation (CPR) had a successful return of spontaneous circulation and the overall mortality rate was 89%. The most common cause of unexpected CA is sepsis, found in 348 out of 1233 patients (28%). The most common medical history accompanied by the ICU patients' medical history is a multi-organ dysfunction, found in 184 out of 1233 (14.9%) patients. We found a weak negative relationship between patients' gender and the causes of unexpected CA (relative risk = −0.069 and P < 0.05). Conclusion: The findings are in line with prior studies confirming that mortality increases when unexpected CA occurs on patients with sepsis. There was no significant relationship seen between patients' age and CPR outcomes.

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