NONINVASIVE CONTINUOUS HEMODYNAMIC AND PETCO(2) MONITORING DURING PEROPERATIVE CARDIAC-ARREST

We describe a cardiac arrest which occurred during general anaesthesia in the prone position for surgical correction of lumbar kyphosis in a patient with Marfan's syndrome Peroperative monitoring was routine with EGG, non-invasive arterial pressure, oximetry, PETCO(2) and central venous pressure, plus aortic bloodflow and systolic time intervals via an oesophageal echo-Doppler device. Forty-five minutes after the start of surgery, a sudden decrease in aortic bloodflow followed by a decrease in PETCO(2) suggested acute cardiac failure despite continuation of the ECG signal. Initial CPR in the prone position produced a slight increase in PETCO(2). When the patient was turned to the supine position and the legs elevated, chest compression was more efficient and spontaneous circulation was rapidly restored. Circulatory arrest could be explained by incompletely treated hypovolaemia, or by myocardial depression (decrease in aortic bloodflow and lengthened pre-ejection period) combined with excessive hypotension in a patient with Marfan's syndrome, thus compromising coronary bloodflow producing ST segment depression. Continuous non-invasive aortic blood flow and PETCO(2) monitoring proved valuable in the early detection and treatment of circulatory arrest and in the evaluation of the efficiency of peroperative CPR.