Cardiac Emergencies in Neurosurgical Patients

Table 5

Cardiac emergencies in spine surgery.

Author	Patient	Procedure	Cardiac rhythm	Cause	Management	Outcome
Stauber et al. [18]	67 y ♀	Epidural steroid in cervical spine	PEA	Blockade of cardiac accelerator fibers	CPR, epinephrine	Mild cognitive dysfunction
Dooney [35]	43 y ♂	Lumbar discectomy	Asystole	Reflex vagal reaction due to dural traction	Atropine, adrenaline, CPR started in prone	No neurological deficits
Sharma et al. [36]	32 y ♂	Lumbar discectomy	Asystole	Intravascular ethanol injection	Atropine	No neurological deficits
Chen et al. [37]	75 y ♀	Lumbar vertebroplasty	Severe bradycardia	Fat embolism syndrome	CPR	Death
Hoell et al. [38]	60 y ♀	Cervical discectomy	Asystole (20 s)	Decreased sympathetic activity; (anterior root irritation)	Interruption surgery	No neurological deficits
Brown et al. [39]	60 ♀	Thoracic spine decompression	Pulseless VT	VAE	Defibrillation	No neurological deficits
Lin et al. [40]	21 y ♀	T2-3 sympathectomy	VF	Sympathetic stimulation (stellate ganglion)	CPR	No neurological deficits
Raptis et al. [41]	24 cases	Lumbar discectomy	Hypotension, cardiac arrest	Vascular injury, hemorrhage	Laparotomy	Death in 7/24
Chow et al. [42]	22 y ♀	T2 sympathectomy	VF (<1 min), bradycardia, complete AV block, asystole (1 min)	Vagal tone	Atropine, epinephrine, CPR	No neurological deficits
Albin et al. [43]	2 patients; both 40 y ♂	Lumbar laminectomy	Asystole ( = 1); PEA ( = 1)		CPR	Death
Ewah and Calder [44]	26 y ♀	L4-5 discectomy	PEA	Aortic laceration	CPR, ephedrine, epinephrine, crystalloid, colloid	Death
McCarthy et al. [45]	18 y ♀	Posterior spinal fusion	Hypotension, cardiac arrest	VAE	CPR (supine), open cardiac massage, vasopressors	No neurologic deficits; death 2° to multisystem failure at 2 weeks
Dumont et al. [46]	38 y ♂	Atlantoaxial arthrodesis	Asystole (minutes)	VAE	Surgical field irrigation, rapid skin closure, CPR (supine)	No neurological deficits

♀ = female gender; ♂ = male gender; VF = ventricular fibrillation; VAE = venous air embolism; CPR = cardiopulmonary resuscitation including chest compressions; no neurological deficits = postoperative deficits not mentioned.