Acute Crit Care.  2019 Feb;34(1):86-91. 10.4266/acc.2016.00794.

Cardiac Arrest from Patient Position Change after Spine Surgery on a Jackson Table

• Hong B
• Yoon SH
• Park SY
• Song S
• Youn A
• Hwang JG

• KMID: 2449385
• DOI: http://doi.org/10.4266/acc.2016.00794

Abstract

The Jackson table has minimal effects on cardiac function because it does not elevate abdominal and thoracic pressures. In addition, it decreases venous congestion and increases exposure of the surgical field. However, the hips and knees are flexed with inappropriate padding, and venostasis is promoted and increased. Pulmonary thromboembolism (PTE) is fatal; thus immediate diagnosis and treatment are essential. However, clinical signs of intraoperative PTE are difficult to discern. Thrombolytic therapy can be considered as first-line therapy, but bleeding limits its use. The authors report a case of PTE resulting from patient positional change after spine surgery, and the use of immediate postoperative recombinant tissue-type plasminogen activator.

Keyword

pulmonary embolism; thrombolytic therapy; tissue plasminogen activator

MeSH Terms

Diagnosis
Heart Arrest*
Hemorrhage
Hip
Humans
Hyperemia
Knee
Pulmonary Embolism
Spine*
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

• 

  Figure 1. Position for spine surgery. Another patient is pictured, having provided informed consent. Hips and knees are flexed, so legs are placed lower than the heart.

• 

  Figure 2. D-shaped left ventricle is observed in transgastric short axis view.

• 

  Figure 3. Tricuspid regurgitation is observed with pressure gradient 49 mmHg.

• 

  Figure 4. Multidetector computed tomography reveals occlusion of both pulmonary arteries with multiple pulmonary thromboembolisms (arrows).

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