Emergency caregiver repair of a severed tracheostomy cuff inflation line in a patient with advanced multiple sclerosis: a case report

Background Cuffed tracheostomy tubes are generally reserved for patients requiring airway protection or mechanical ventilation, whereas cuffless tubes are typically preferred for long-term airway management when aspiration risk is low. Device malfunction involving the tracheostomy cuff system can rapidly compromise airway protection and may lead to aspiration. Case presentation We describe a case involving a 42-year-old male with advanced multiple sclerosis (MS) and severe neuromuscular impairment who required long-term use of a cuffed tracheostomy tube due to recurrent aspiration during trials of cuffless tubes. The patient inadvertently pulled the cuff inflation line from the pilot balloon, resulting in rapid cuff deflation and imminent aspiration risk. Immediate access to emergency medical services and tracheostomy tube replacement was not feasible. The patient’s caregiver performed an emergency repair by trimming the severed inflation line, reinserting it into the pilot balloon, and sealing the connection with cyanoacrylate adhesive. The cuff was successfully reinflated, restoring airway protection. The modified device remained functional for four days until scheduled tracheostomy tube replacement by the clinical tracheostomy team. Conclusion Self-modification of tracheostomy devices is not recommended and carries potential risks. However, this case illustrates an exceptional emergency scenario in which a caregiver’s improvised repair restored cuff function and likely prevented aspiration. The report highlights the importance of caregiver training, emergency preparedness, and ready access to spare tracheostomy equipment in home-managed tracheostomy patients.