Arkansas Children’s ENT Expert Saves Teenage Bull Rider’s Life After Airway Explodes

Eight seconds mean everything to Cayson Hall.

"I just love the rush and the feeling of riding your bull," said the 15-year-old from Missouri, explaining his love of competitive bull riding, which requires staying on a bucking bull for eight seconds. "And hearing the crowd cheers is one of the best parts about it, knowing people are watching you doing what you love."

Cayson’s passion overrides the risks he became intimately aware of after roughly seven months of bull riding.

On March 9, 2024, during a junior bull riding competition in Natural Dam, Ark., Cayson was bucked off his bull, a horn smashing into his throat. While his skin was not punctured, "his airway was completely exploded," explained his stepmother, Ashlee Hall.

Over the course of a year and a half of 11 surgeries and rehabilitation, Cayson had one persistent question: “When can I get on another bull?”

But for his family, the only question that mattered was whether Cayson would survive and thrive. Thanks to Arkansas Children’s pediatric ENT specialist Andre’ M. Wineland, M.D., and his team, the answer was yes.

"We had a saying; we always said, 'But God.' He probably wasn't supposed to be here. But God blessed us with an incredible team at Arkansas Children's Hospital (ACH) in Little Rock. Dr. Wineland being on that night, we feel like we owe it all to him for Cayson still being here," Ashlee said.

‘Got tougher’

Rodeo roots run deep for the Hall family. Cayson watched his parents compete, and his father, Dustin Hall, achieved six world titles in the Professional Bull Riders (PBR) circuit. His stepmother also grew up barrel racing and horseback riding.

As a young child, Cayson began Mutton Bustin’, riding sheep, but declared to his parents, “Bull riding was just stupid and guys got ran over and he would never do that,” Dustin said.

But once he became a teenager, everything changed.

"I just got tougher," Cayson explained with a gritty, raspy tone his voice now carries. It's a lingering reminder of just how tough he had to be.

On the day of his accident, Cayson rode two bulls. The first ride hit a snag - his hand got stuck in his rope, and the bull dragged around the arena after bucking him off. His dad taped his arm up so his joint wouldn't dislocate during his second ride.

About an hour and a half later, he rode his second bull.

"He reared up in the chute with me, and he was acting up and all that. When I nodded (for them to open the chute), I remember feeling him dip left and he jumped real high in the air and tried to go right. I remember getting slung forward. Then I just remember being in the arena, coughing up blood," Cayson said.

Ashlee initially thought Cayson was stunned after hearing a “clack” that sounded like he hit his helmet.

"I'll never forget his face when I walked into the arena," Ashlee said through tears. "He looked right at me with his big eyes and went like this (motioned) to me, like to come here, and his color was really bad. He was gray. He was struggling to breathe, like started breathing really hard, and he was coughing up blood."

Cayson's mother quickly called for an ambulance. Ashlee, a former anesthesia tech, and other medical professionals in the stands assisted in stabilizing him.

By the time he was med-flighted to ACH by an outside flight company, it had been 2 ½ hours since the accident.

"A gentleman in the arena just started praying really loud over everybody. And at that moment, it was like a warm feeling coming over you, like someone was giving you a hug. And there was no denying like the presence of God there," Ashlee said. "At that moment, I watched his pulse oxygen start climbing from 83% and he stayed between 96% and 98% on room air until the ambulance got there with oxygen. Talking to Dr. Wineland, he will tell you there's no denying that that was a miracle, because with Casey's injury, there's no way he should have been able to maintain that."

‘I do not want to die’

Dr. Wineland, a pediatric ear, nose and throat (ENT) specialist and head and neck surgeon at ACH and associate professor in pediatric otolaryngology at the University of Arkansas for Medical Sciences (UAMS), treats a variety of head and neck injuries, including gunshot and bow and arrow wounds and ATV or vehicle accidents. But he admitted, “I’ve never seen a bull riding accident and nothing in my 15-plus years of training ever seen an injury like Cayson’s.”

"He could not talk, but he could write. And the last thing he wrote and handed to me, he said, 'I do not want to die.' I said, 'Buddy, you're not going to die,'" Dr. Wineland said.

However, there was no guarantee that Cayson would ever be able to talk or eat normally again. Dr. Wineland put in a tracheostomy tube or "trach," a tube surgically inserted in the trachea (the windpipe in the throat) to allow air to get into Cayson's lungs, bypassing his nose, mouth and throat.

"It was like a bomb had gone off, and it was nothing short of a miracle that I was able to secure his airway. His injury was completely devastating. Once we secured his airway, we have to look at other injuries, and that's kind of the whole process that unfolded," Dr. Wineland said. "And the way I told the family, it's like if you put together a puzzle on your table and then lifted it off and dropped it and then randomly took pieces and cut them in half and then try to put it together the puzzle. That's kind of what we would do."

After about nine days in a medically induced coma, Cayson woke up asking when he could ride again.

However, Cayson's journey was just beginning. Pulling in "15 years of knowledge all in one case," Dr. Wineland explained each of Cayson's 11 surgeries he performed over the next year and a half, like reconstructing his vocal cords, served a specific purpose in repairing his airway to swallow, breathe and eventually remove the trach.

The throat consists of muscles, tissues and cartilage, and when a traumatic accident like Cayson’s occurs, it loses structure.

"The bottom of his airway is kind of the support frame - think like the foundation for your house. So once that fell, everything kind of collapsed into it as well. ... It's like a balloon popped inside and everything became destroyed," Dr. Wineland said. "Not only are we dealing with physical things that were destroyed, we're also dealing with nerves that control muscles and have sensory function."

Some of those procedures within his surgeries included:

• Microlaryngoscopy: To repair and examine the larynx, or voice box, and vocal cords.
• Bronchoscopy: To repair and examine the trachea, or windpipe, and the bronchi, passages that move air to and from the lungs.
• Supraglottoplasty (partial arytenoidectomy) with carbon dioxide laser: A complex procedure to restore the airway.

‘Best option for his care’

Cayson spent 47 days at ACH, with 13 in the Pediatric Intensive Care Unit. There were countless memories, like card games with nurses who became like family, as well as continuous support from the care team at ACH. In addition to his ENT surgeries, he had a gastronomy, or G-tube, temporarily placed into his stomach to receive nutrients, fluids and medication, by ACH Pediatric Surgeon Jeffrey Burford, M.D., the National Surgical Quality Improvement Program pediatric surgeon champion at ACH and an associate professor of surgery at UAMS.

Ashlee quit her job to stay home and provide full-time care to Cayson. It was the little things, like Cayson eating mashed potatoes, to the big moments, like speaking for the first time, that were both monumental celebrations. While the family lives in Lebanon, Mo., about nine hours away round-trip, closer to other children's hospitals, seeing Dr. Wineland at ACH was never a second thought.

‘A wonderful feeling’

"We chose to keep bringing Cayson back to Arkansas Children's, even though we had options in Missouri for children's hospitals that were closer to our home. We felt like this was our best option for his care. And honestly, nobody back home wanted to touch what Dr. Wineland had done because it was such extensive work," Ashlee said. "And again, we just really feel like we owe it to Dr. Wineland for Cayson still being able to be here today, so we wanted to make sure that he was in the best hands possible. And we felt like that was here with Dr. Wineland at Arkansas Children's."

On Sept. 7, donning custom hot pink chaps with white and teal fringe and etched in crosses, Cayson was ready. Riding two steers and a small bull, he said his only fear was "looking stupid" if bucked off.

He lasted eight seconds.

His dad admits he’s terrified to see him riding again.

"He's going to do it when he turns 18 in (about) two years anyway because he loves it so much, so we just chose and decided to guide him and help him along the way," Dustin said. "We just take trust in God."

On Cayson's last follow-up appointment with Dr. Wineland, Sept. 19, he excitedly showed him the video of his first bull ride since the accident. While Dr. Wineland said "it did make my stomach turn just a bit," Cayson's joy is the reason he works at ACH.

"An injury like Cayson's could be devastating. It could be really, not only in the moment, life-threatening, but profoundly devastating throughout most of his life. The ability to change course and to help that, I mean, I'm speechless. There's nothing that can compare," Dr. Wineland said. "So, seeing him do well and smile and wear his cowboy boots and cowboy hat just reaffirms that all the years and years of hard work that it took to get here paid off. At the end of the day, that's what it's about - it's helping kids maximize their potential, and it's just a wonderful feeling."

This article was written by the Arkansas Children’s content team and medically reviewed by Andre’ M. Wineland, M.D.
Photos: Cayson Hall, 15, shows off his scar where a bull's horn hit his throat. In the second photo, he poses with his custom chaps.