Penetrating firearm tracheal injury with cardiac arrest due to tension pneumopericardium

Firearm-associated tracheal injuries occur infrequently and as such there is no standard approach. We present a case of tension pneumopericardium due to a firearm-associated tracheal injury which was successfully repaired through an anterior midline sternotomy approach. In hemodynamically unstable patients who cannot tolerate posterolateral approaches, the anterior midline sternotomy approach to the airway should be considered. We demonstrate that this approach can provide adequate access for decompression of tension physiology and repair of airway injury.