Cardiac Arrest During Spinal Surgery: A Multidisciplinary Approach and Management of Takotsubo Syndrome

Abstract

Cardiac arrest (CA) in the operating room is rare. Among known perioperative CA causes, Takotsubo syndrome (TTS) is a well-recognized one. Perioperative TTS is more common than existing reported cases therefore anesthesiologists should be aware of its diagnosis and management. TTS is an acquired and selflimited stress cardiomyopathy usually triggered by a precipitating stress factor and should be considered in any hospitalized patient presenting with symptoms such as acute coronary syndrome, cardiac arrhythmias or CA. A 67-year-old woman presented for lumbar discectomy in knee-chest position suffered CA two hours after the beginning of surgery. After a thorough examination, TTS was determined as the cause. This case report highlights the importance of TTS as a differential diagnosis of CA in the intraoperative setting as well as the usefulness of multimodal monitoring with cerebral monitoring to assist the prompt pulseless electric activity diagnosis. To our knowledge, this is the first case report in such circumstances.

Takotsubo Cardiomyopathy Mimicking Multivessel Coronary Artery Disease Following Spinal Surgery

“…Takotsubo cardiomyopathy can occur following spinal surgery, as evidenced by cases reported in various contexts. For instance, a 67-year-old woman developed TC during a lumbar discectomy [ 19 ]. Additionally, TC has been linked to acute hydrocephalus after posterior fossa tumor resection, causing cardiac dysfunction in a two-year-old girl [ 20 ].…”

Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery

“…TCM presents with varying patterns of wall motion abnormalities of the ventricles. The apical ballooning pattern is no longer considered pathognomonic for the syndrome 1,6,7 . A hallmark of TCM is full reversibility of the left ventricle contraction abnormalities within weeks.…”

Identifying the trigger of Takotsubo syndrome is challenging when several of them are present

“… 3 Cardiac arrest was also reported in a patient with TTS caused by spinal surgery. 4 Cardiac arrest also occurred in a patient who experienced bronchoscopy-induced TTS. 5 …”