Non-invasive continuous haemodynamic andPetCO2 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 ECG, non invasive arterial pressure, oximetry,PetCO2 and central venous pressure, plus aortic blood flow and systolic time intervals via an oesophageal echo-Doppler device. Forty-five minutes after the start of surgery, a sudden decrease in aortic blood flow followed by a decrease inPetCO2 suggested acute cardiac failure despite continuation of the ECG signal. Initial CPR in the prone position produced a slight increase inPetCO2. 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 blood flow and lengthened pre-ejection period) combined with excessive hypotension in a patient with Marfan’s syndrome, thus compromising coronary blood flow producing ST segment depression. Continuous non-invasive aortic blood flow andPetCO2 monitoring proved valuable in the early detection and treatment of circulatory arrest and in the evaluation of the efficiency of peroperative CPR.