Cardiac arrest during spine surgery in the prone position: Case report and review of the literature.

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Cardiac arrest during spine surgery in the prone position: Case report and review of the literature.

World Neurosurg. 2018 Apr 25;:

Authors: Staartjes VE, Schillevoort SA, Blum PG, van Tintelen JP, Kok WE, Schröder ML

Abstract
OBJECTIVE: Intraoperative cardiac arrest (CA) is usually attributable to pre-existing disease, or to intraoperative complications. In rare cases, intraoperative stress can demask certain genetic diseases, such as Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). It is essential that neurosurgeons are aware of the etiologies, risk factors, and initial management of CA during surgery in the prone position.
METHODS: We present a case of CA directly after spinal fusion for lumbar spondylolisthesis, and review the literature on cardiac arrests during spinal neurosurgery in the prone position. In particular, we focus on etiologies of CA in patients with structurally normal hearts.
RESULTS: After resuscitation, the 53 years old female patient achieved return of spontaneous circulation after 17 minutes, without any neurological deficits and with substantial improvement of functional disability and pain scores. Extensive imaging, stress testing, and genetic screening ruled out common etiologies of CA. In this patient with a structurally normal heart, CPVT was established as the most likely cause. We identified 18 further cases of CA associated with spinal neurosurgery in the prone position. Most cases occurred during deformity or fusion procedures. Commonly reported etiologies of CA were air embolism, hypovolemia, and dural traction leading to vasovagal response. In patients with structurally normal hearts, inherited arrhythmia syndromes including CPVT, Brugada Syndrome, and Long-QT-Syndrome should be included in the differential diagnosis, and specifically tested for.
CONCLUSIONS: Although intraoperative CA are rare during spine surgery, neurosurgeons should be aware of the etiologies, and the specific difficulties in the management associated with the prone position.

PMID: 29704693 [PubMed - as supplied by publisher]

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