Percutaneous tracheostomy (PCT) has rapidly emerged in recent years; it is proven to be safe and less time-consuming when compared to surgical technique. In critical care settings, the use of PCT has been widely accepted and some authors consider it the gold standard method. Although PCT is relatively a safe procedure, it still can be associated with some serious complications. Massive percutaneous emphysema is a rare complication of PCT, which might be life-threatening. We report a patient with Guillian-Barre syndrome (GBS), who was admitted to an intensive care unit and required prolonged ventilation. Bedside PCT was performed and ended with the development of an immediate diffuse massive surgical emphysema and desaturation, followed by cardiac arrest regardless of the treatment measures