Intraoperative Cardiac Arrest During Anterior Cervical Discectomy and Fusion Due to Takotsubo Cardiomyopathy: A Case Report

Intraoperative cardiac arrest is a rare but life-threatening complication of non-cardiac surgery and may result from anesthetic effects, surgical events, or acute cardiopulmonary pathology. We report the case of a 50-year-old man without known structural heart disease who underwent elective C5-C7 anterior cervical discectomy and fusion and developed pulseless cardiac arrest intraoperatively. After approximately 80 minutes of stable anesthesia and completion of the discectomy portion of the operation, end-tidal carbon dioxide abruptly fell to zero and the patient was found to be pulseless. Advanced Cardiac Life Support (ACLS) was initiated for asystole evolving to pulseless electrical activity, with return of spontaneous circulation (ROSC) followed by a second arrest requiring repeat resuscitation and subsequent sustained ROSC. Point-of-care echocardiography demonstrated severe new left ventricular systolic dysfunction with apical akinesis and basal hyperkinesis. Cardiac biomarkers were elevated. Emergent coronary angiography demonstrated no obstructive coronary artery disease, and left ventriculography revealed apical ballooning consistent with Takotsubo cardiomyopathy. The patient required temporary vasoactive and inotropic support, improved hemodynamically within 48 hours, and demonstrated complete recovery of left ventricular systolic function by postoperative day 5 with full neurologic recovery. This case highlights Takotsubo cardiomyopathy as an important consideration in unexplained intraoperative cardiovascular collapse.