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

Background Bronchoscopic biopsy in elderly patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) presents high procedural risks. This case study analyzes the critical care nursing trajectory of an 76-year-old patient who survived a massive endobronchial hemorrhage and subsequent in-hospital cardiac arrest (IHCA) during an interventional procedure. Resentation An 76-year-old male with severe COPD (FEV1 40% predicted) and hypertension underwent diagnostic bronchoscopy. Immediately following mucosal biopsy, the patient developed massive hemorrhage (approx. 300 mL), leading to acute asphyxia and pulseless electrical activity (PEA). The critical care nursing team initiated a rapid response, facilitating emergency tracheal intubation and localized hemostasis using epinephrine irrigation. Return of spontaneous circulation (ROSC) was achieved after 6 min of advanced life support. Nursing interventions The nursing management focused on three critical phases: (1) Crisis Resource Management (CRM): utilizing rapid situational awareness to clear the airway and coordinate multidisciplinary resuscitation; (2) Post-ROSC Stabilization: implementing lung-protective ventilation and precise cuff pressure titration (25–30 cmH 2 O) to prevent re-bleeding and ventilator-associated complications; and (3) Secondary Prevention: managing the delicate balance between necessary anticoagulation for cardiovascular comorbidities and the risk of recurrent pulmonary hemorrhage during the recovery phase. Conclusion This case report documents the successful resuscitation of an 76-year-old male with severe AECOPD (FEV1 40% predicted) who developed massive endobronchial hemorrhage (~ 300 mL) and in-hospital cardiac arrest (pulseless electrical activity) during diagnostic bronchoscopy. Detailed preoperative risk stratification, intraoperative crisis resource management, and post-ROSC intensive care nursing interventions are described and analyzed. A comprehensive geriatric assessment, complete resuscitation parameters, functional outcomes, and a comparative discussion with existing literature on bronchoscopy-related airway hemorrhage are provided. A nine-phase nursing decision-making framework for high-risk bronchoscopy in elderly AECOPD patients is proposed. This report highlights the critical role of nursing-led situational awareness, structured crisis management, and dynamic hemodynamic titration in navigating catastrophic cardiopulmonary events in high-risk elderly populations. Clinical trial number not applicable.