Venous Air Embolism During Lumbar Spine Surgery Leading to Cardiac Arrest Requiring Prone Chest Compressions

Case report: A 76-year-old female patient underwent revision T12-L4 decompression and fusion surgery. During the procedure, a large dural defect occurred associated with an abrupt drop in end-tidal CO 2 , severe hypotension, bradycardia, and cardiac arrest. Prone chest compressions were initiated, and the patient survived without postoperative comorbidities. The sudden hemodynamic instability was attributed to a venous air embolism (VAE) confirmed by findings on intraoperative capnography. Conclusion: Managing cardiac arrest caused by VAE in lumbar spine surgery is challenging. This case showcases that prone chest compressions may lead to better survival chances compared with waiting to initiate supine chest compressions.