Successful defibrillation in the prone position

Prone cardiopulmonary resuscitation in elderly undergoing posterior spinal fusion with laminectomy

An 80-year-old male patient presented with 2 weeks history of low back pain undergoing posterior spinal fusion with laminectomy in the prone position. The patient was induced with fentanyl, propofol, and rocuronium, and then he was positioned in the prone position. After 6 h of starting the surgery, the patient started to be hypotension and bradycardia followed by pulseless electrical activity (PEA). Code blue was activated intraoperatively with immediate initiation of cardiopulmonary resuscitation (CPR) in the prone position and multiple epinephrine boluses. Fortunately, the patient had return of spontaneous circulation. After stabilization, he was taken for computed tomography scan which showed massive pulmonary embolization and management was continued in the intensive care unit. CPR in the prone position has shown to be effective for return of spontaneous circulation after PEA.

Successful use of wearable cardioverter defibrillator in a patient with dextrocardia and persistent left superior vena cava

Congenital disorders, such as dextrocardia and persistent left superior vena cava, are rare. However, their presence is often associated with other cardiac anomalies, and may lead to lethal ventricular tachyarrhythmias, which result in sudden cardiac death. Treating patients with these disorders can present a challenge to clinicians, as it may cause technical difficulties during interventional procedures, and more often, altered defibrillation techniques in a setting of prehospital sudden cardiac arrest. This report describes the first case of successful defibrillation therapy delivered by the wearable cardioverter defibrillator to a patient with dextrocardia and persistent left superior vena cava during a ventricular tachycardia arrest.