Asystole after cementing 20 spinal screws, and CPR done face-down
During spine surgery, a 76-year-old woman went into asystole right after bone cement was placed. She was resuscitated while still prone and survived neurologically intact.
This is a single case report, so it cannot show how often this happens. A 76-year-old woman with severe osteoporosis, rheumatoid arthritis and Parkinson's disease was having surgery for failure of a previous spinal construct. Right after cement was placed around 20 pedicle screws, her oxygen saturation and end-tidal CO2 dropped, followed by low blood pressure, a slow heart rate and asystole.
The team performed CPR with her still lying prone and gave 1 mg of epinephrine. Circulation returned, and a ventricular tachycardia was cardioverted. Echocardiography showed a hyperdynamic heart without right ventricular dilation, and CT angiography excluded a major pulmonary embolism, though it showed tiny cement deposits and a leak near the vertebrae.
The authors suggest an immune or humoral-mediated vasoplegia with relative loss of preload triggered a Bezold-Jarisch reflex. This mechanism is an interpretation, not proven. She survived neurologically intact.
Summary prepared with AI assistance from the published abstract and reviewed by a physician. Not medical advice. Learn more
