Abstract
Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Of note, this embolus disappeared completely and rapidly after return of spontaneous circulation. TEE proved to be useful in the diagnosis and management of this case of PEA.
Highlights
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance, and cardiac arrest
We report the case of BCIS diagnosed by transesophageal echocardiography (TEE) during pulseless electrical activity (PEA)
We learned that intravascular emboli caused by BCIS can extend from the main pulmonary artery to the inferior vena cava and can disappear completely within approximately 60 min
Summary
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance, and cardiac arrest. Case presentation A 93-year-old woman, with no history of cardiac disease or venous thrombosis, presented with left neck femur fracture. She was scheduled for cemented femoral head hemiarthroplasty. (2019) 5:5 for 12 h to correct persistent hypotension She was extubated 36 h after surgery and remained 4 days in the ICU. She was discharged 33 days post-operatively, with no apparent neurologic sequelae. Her hospital stay was prolonged due to development of a small lower limb deep vein thrombosis, but it was not thought that this was related to her large intra-operative embolism
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