Prone CPR After Cementation-Induced Vasoplegia and Bezold-Jarisch Asystole in Spine Surgery
Carlos Rafael Ramírez-Paesano, Juan Diego Villegas-Alzate, Yerlin Andrés Colina-Vargas, Rudolf Morgenstern, Christian MorgensternCase:
A 76-year-old White woman, with severe back pain, severe osteoporosis, rheumatoid arthritis, Parkinson's disease, and hypertension, presented with proximal junctional failure and progressive thoracic kyphosis and developed abrupt SpO 2 /EtCO 2 decline, hypotension, bradycardia, and asystole immediately after cementing 20 pedicle screws. Prone CPR and 1 mg epinephrine achieved return of spontaneous circulation; ventricular tachycardia was cardioverted. TEE showed a hyperdynamic heart without RV dilation. CTA excluded major PE, revealing tiny polymethylmethacrylate deposits and perivertebral leak.
Conclusion:
Findings suggest immunohumoral vasoplegia with relative preload loss triggering a Bezold-Jarisch reflex. Early recognition, prone CPR, and POCUS-guided, goal-directed resuscitation enabled neurologically intact survival.