Anest. intenziv. Med. 2026;37(3):156-161 | DOI: 10.36290/aim.2026.027

Airway bleeding - a narrative review and case vignetteReview Article

Tlapáková K. ORCID...^{1, 2}, Černá Pařízková R. ORCID...^{1, 2}, Dostál P. ORCID...^{1, 2}, Polák J.¹, Chovanec V. ORCID...^{2, 3}, Šatánková J. ORCID...^{2, 4}, Koblížek V. ORCID...^{2, 5}, Dulíček P. ORCID...^{2, 7}, Astapenko D. ORCID...^{1, 2, 6, 8, 9}

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové

² Lékařská fakulta v Hradci Králové, Univerzita Karlova

³ Radiologická klinika, Fakultní nemocnice Hradec Králové

⁴ Klinika otorinolaryngologie a chirurgie hlavy a krku, Fakultní nemocnice v Hradci Králové

⁵ Plicní klinika, Fakultní nemocnice Hradec Králové

⁶ Fakulta zdravotnických studií, Technická univerzita v Liberci

⁷ IV. interní hematologická klinika, Fakultní nemocnice Hradec Králové

⁸ Vojenská lékařská fakulta, Univerzita obrany

⁹ Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Airway bleeding, particularly massive or life‑threatening hemoptysis, represents an emergency associated with high morbidity and mortality. The cornerstone of management is rapid airway management, hemodynamic stabilisation, exclusion of pseudohemoptysis, and early diagnosis of the cause and source of bleeding using imaging and endoscopic methods. The current literature highlights the key role of bronchoscopy, which enables identification of the bleeding source, local hemostatic interventions, clot removal, and lung isolation. Bronchial artery embolisation has become the standard treatment for massive and recurrent hemoptysis of bronchial artery origin due to its high immediate success rate, despite a non‑negligible risk of recurrence and complications. In rare cases in which adequate ventilation cannot be maintained despite exhausting bronchoscopic, endovascular, and surgical techniques, extracorporeal membrane oxygenation (ECMO) may be considered a rescue modality. This article reviews the current knowledge on the diagnosis and treatment of airway bleeding with a focus on hemoptysis, the role of bronchoscopy and bronchial artery embolisation, and is complemented by a case vignette of a patient with life‑threatening diffuse airway bleeding in whom venovenous ECMO was used to provide ventilatory support while extensive intrabronchial clots were temporarily left in place as a local tamponade.

Keywords: airway bleeding, bronchoscopy, bronchial artery embolisation, ECMO.

Received: March 1, 2026; Revised: July 13, 2026; Accepted: July 16, 2026; Prepublished online: October 7, 2026; Published: October 14, 2026  Show citation