Cardiac Resuscitation in the Lateral Position and the Potential Role of Intraoperative Simulation: A Case Repor

Background

Intraoperative resuscitation of patients in positions other than supine is inherently difficult. Rapidly returning patients supine requires a coordinated effort and is seldom rehearsed by theatre teams.

Case presentation

A 77-year-old female with severe pulmonary hypertension was scheduled to undergo a hemiarthroplasty repair for a fractured neck of femur. Under general anesthesia in the left lateral decubitus position, a massive embolus provoked during cement pressurization of the femur caused cardiovascular collapse and irretrievable right heart failure. Cardiac compressions were performed in the lateral position for approximately 8 minutes before the patient was turned supine. Intraoperative death was declared after 25 minutes of ACLS.

Conclusions

We suggest there is a role for developing an in situ intraoperative simulation program inclusive of all operating room team members that focuses on the resuscitation of patients positioned other than supine.