Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy that manifests with acute and massive bleeding. We present a patient who deveoloped a TIF and underwent a division of the fistula, interrupting the innominate artery. Successful management of a patient with TIF requires the rapid institution of specific resuscitative and operative measures. The patient arrived at the emergency room with acute massive tracheal bleeding, respiratory difficulty, decreased consciousness and ensuing cardiac arrest. After the tracheal cuff was fully inflated, cardiopulmonary resuscitation was started. Fortunately, the bleeding was stopped and heart rate and blood pressure were normalized. Before performing the cerebral angiography, the patient was intubated orally for rebleeding. The patient was admitted to the intensive care unit and stayed for 29 days due to weaning failure from the ventilator. After repair of tracheal stenosis, a permanent tracheostomy was instituted. The patient had no respiratory difficulty or massive tracheal bleeding during the 2 months after discharge except one episode of minor bleeding.