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Brain & Heart

CASE REPORT
Perioperative cardiopulmonary resuscitation in a

prone position: A case report

†
Geraldine Raphaela B. Jose * , Cristina C. Arcinue-Gomez † , and
Maryko G. Guinto
Department of Anesthesiology, Division of Neuroanesthesia, College of Medicine-Philippine General
Hospital, University of the Philippines, Manila, Philippines

Abstract

Post-cardiac arrest brain injury remains a major cause of mortality in perioperative
cardiac arrest, although intraoperative events are uncommon due to pre-procedural
preparations, risk-benefit anticipation, and a controlled working environment.
Herein, we describe the successful cardiopulmonary resuscitation of a 57-year-old
male with a C2-C3 schwannoma who experienced intraoperative cardiac arrest due
to massive blood loss during a C2-C3 laminectomy and excision of tumor while in a
prone position. The intricacies and effectiveness of resuscitation in a prone position,
as well as neuroprotective strategies in the perioperative setting to optimize
functional outcomes, will be discussed.

Keywords: Post-cardiac arrest brain injury; Intraoperative resuscitation in a prone position;
†These authors contributed equally Intraoperative cardiac arrest; Neuroprotection; Intraoperative massive blood loss
to this work.
*Corresponding author:
Geraldine Raphaela B. Jose
(gbjose@up.edu.ph) 1. Background
Citation: Jose GRB,
Arcinue-Gomez CC, Guinto MG. Cardiac arrest is one of the leading causes of morbidity and mortality worldwide.
Perioperative cardiopulmonary Intraoperative cardiac arrest has been recorded as high as 5.7/10,000 procedures,
resuscitation in a prone position:
A case report. Brain & Heart. increasing the predictability of inpatient mortality and significantly higher hospital
2024;2(3):3392. costs. Many clinical interventions have been established to enhance the return of
1
doi: 10.36922/bh.3392 spontaneous circulation (ROSC). Optimizing post-cardiac arrest resuscitation is as
Received: April 9, 2024 important as the advancements in basic and advanced life support for the best chance of
Accepted: June 17, 2024 survival with good neurological function. 2
Published Online: August 22, 2024 Global ischemia occurs immediately after ROSC, leading to consequential insults that
aggravate multi-organ injury during and after reperfusion. Post-cardiac arrest brain injury
3,4
Copyright: © 2024 Author(s).
This is an Open-Access article has been identified as the main cause of mortality in 68% and 23% of cases after out-of-hospital
distributed under the terms of the and in-hospital cardiac arrest, respectively, due to poor awareness and low implementation
5
Creative Commons Attribution of neuroprotective efforts following successful cardiopulmonary resuscitation (CPR). 6
License, permitting distribution,
and reproduction in any medium, Critical care monitoring, early hemodynamic optimization, oxygenation and
provided the original work is
properly cited. ventilation, circulatory support, normoglycemia, seizure control and prevention, and
neuroprotective pharmacology are all essential neuroprotective strategies to reduce
Publisher’s Note: AccScience
Publishing remains neutral with brain injury post-cardiac arrest. 2
regard to jurisdictional claims in
published maps and institutional Herein, we describe our experience in the successful delivery of perioperative CPR
affiliations. on a patient who was at risk for cardiac arrest due to intraoperative hypovolemic shock.

Volume 2 Issue 3 (2024) 1 doi: 10.36922/bh.3392