Intraoperative Cardiac Arrest in Orthopaedic Surgery: A Case Series of 42 Patients

INTRODUCTION: Intraoperative cardiac arrest (IOCA) is a rare event during orthopaedic surgery. Although infrequent, it has a notable effect, with mortality as high as 35%. Little is known about the outcomes of IOCA in orthopaedic surgery, and this study aims to fill that knowledge gap to improve patient counseling and treatment decisions. METHODS: A retrospective review of a single health system over a 20-year period identified 42 patients who experienced IOCA during orthopaedic surgery. Patient characteristics, procedure details, cardiac event specifics, and postoperative complications with an emphasis on morbidity and mortality were collected. RESULTS: Return of spontaneous circulation (ROSC) was achieved in 88% (37 of 42) of patients. In-hospital death following successful resuscitation occurred in 22% (8 of 37) of patients. In those who survived their hospitalization (29 of 42, 69%), 59% (17 of 29) required additional treatment for medical complications acquired secondary to their arrest. IOCA occurred most often during spinal surgery, intramedullary nailing, and cemented endoprosthetic reconstruction, accounting for one-half of cases. Pulmonary embolism was the most common cause of IOCA. In patients requiring case abortion with rapid closure and a delayed return to the operating room for case completion, the infection rate was 40%. CONCLUSION: The majority of orthopaedic surgery patients achieve ROSC following IOCA. For patients who achieve ROSC, two-thirds had either subsequent in-hospital death or a long-term medical complication secondary to their arrest. These findings suggest that a cautious prognosis is indicated even after a successful resuscitation. LEVEL OF EVIDENCE: IV.