Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 3 2024 07 31 216 219 Yasmin Chaibakhsh Cardiac intensive care unit, Rajaei cardiovascular heart center Ziae Totonchi Cardiac intensive care unit, Rajaei cardiovascular heart center Nader Givtaj Cardiac intensive care unit, Rajaei cardiovascular heart center Nahid Aghdaei Cardiac intensive care unit, Rajaei cardiovascular heart center Maryam Ghadimi Cardiac intensive care unit, Rajaei cardiovascular heart center 2024 01 16 2024 09 03 Tracheostomy is a widely used procedure for airway maintenance and long-term ventilation of critically ill patients in ICUs or operating rooms. Although several complications, such as bleeding, leakage, infection, and stenosis, have been previously reported due to tracheostomy, cuff herniation is a rare complication of this commonly performed procedure. The first sign of herniation is a sudden drop in oxygen saturation. Since cuff herniation is not among the first differential diagnoses for a drop in oxygen saturation, it should be considered in the absence of other common causative agents. In this study, we delineate a case of tracheostomy cuff herniation after cardiac arrest in a 64-year-old woman who underwent coronary artery bypass graft surgery. The patient experienced a cerebrovascular accident and mediastinitis postoperatively, necessitating tracheostomy due to extended tracheal intubation, during which the cuff herniated for the first time. Furthermore, a repeat tracheostomy was performed; however, the patient ultimately expired due to complications from mediastinitis. https://rhythm.tums.ac.ir/index.php/jthc/article/view/2003