Intraoperative cardiac  arrest in the prone position in neurosurgery: A reel challenge for the anesthesiologist

Masad Ilyass; Abouelalaa Khalil; Jaafari Abdelahamid; Mezyane Mohamed; Doghmi Naoufal; Elwali Abderrahmane; Baite Abdelouahed; Bensghir Mustapha

doi:10.18535/ijsrm/v10i12.mp03

Abstract

The Cardiac Arrest in Elective Neurosurgery, is complex and different from other types, as it’s influenced by the patient’s position, the surgical procedure, and the equipment used to fix the skull;

we report a case of a patient admitted for lumbar spine surgery in prone position who presented an intraoperative cardiac arrest.

chest compressions can be started immediately for prone patients; some studies confirmed the efficacy of back compressions but patients should be turned supine if possible.

When defibrillation were necessary in patients ventilated in the prone position, defibrillation should be attempted, as placing the patient in the supine position would take precious minutes and would reduce the chances of successful defibrillation.

Evidence is rare when dealing with neurosurgical patients, and more efforts are needed in understanding the etiologies, mechanisms and the specificities of its management.

Keywords

Cardiac arrestProne positionNeurosurgeryCardio pulmonary resuscitation

References

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[refR-1] Li G., « Intraoperative cardiac arrests in adults undergoing noncardiac surgery: incidence, risk factors, and survival outcome. », Anaesthesiology, p. 1018‑1026, 2012.Google Scholar ↗

[refR-2] Chowdhury T, Prabhakar H, Bithal PK, Schaller B, Dash HH. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study. Saudi J Anaesth. 2014 Jul;8(3):335–41.Google Scholar ↗

[refR-3] Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, et al. Cardiopulmonary resuscitation of adults in the hospital: A report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003 Sep 1;58(3):297– 308.Google Scholar ↗

[refR-4] Ramachandran SK, Mhyre J, Kheterpal S, Christensen RE, Tallman K, Morris M, et al. Predictors of Survival from Perioperative Cardiopulmonary ArrestsA Retrospective Analysis of 2,524 Events from the Get With The Guidelines-Resuscitation Registry. Anesthesiology. 2013 Dec 1;119(6):1322–39.Google Scholar ↗

[refR-5] Cardiac Emergencies in Neurosurgical Patients [Internet]. [cited 2020 Sep 21]. Available from: https://www.hindawi.com/journals/bmri/2015/751320/Google Scholar ↗

[refR-6] Kwee MM, Ho Y-H, Rozen WM. The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines. Int Surg. 2015 Feb;100(2):292–303.Google Scholar ↗

[refR-7] Anez C, Becerra-Bolanos A, Vives-Lopez A, Rodriguez-Perez A. Cardiopulmonary Resuscitation in the Prone Position in the Operating Room or in the Intensive Care Unit: A Systematic Review. Anesth Analg. 2021 Feb;132(2):285–92.Google Scholar ↗

[refR-8] « 2005 American Heart As- sociation Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care ».Google Scholar ↗

[refR-9] Wei J, Tung D, Sue S-H, Wu S-V, Chuang Y-C, Chang C-Y. Cardiopulmonary resuscitation in prone position: a simplified method for outpatients. J Chin Med Assoc JCMA. 2006 May;69(5):202–6.Google Scholar ↗

[refR-10] D. C. N. C. C. Miranda, « Successful Defibrilla- tion in the Prone Position », British Journal of Anaesthesia, p. 937‑938, 2000.Google Scholar ↗

[refR-11] « Resuscitation Council (UK). Resuscitation Guidelines 2010. » www.resus.org.uk/pages/guide.htm.Google Scholar ↗