Intraoperative Massive PE Causing Bradyasystolic Arrest During Spinal Surgery

Proposal Number:


Proposal Type:

Medically Challenging Case Report Poster 


Usama Siddique  
Stony Brook University Hospital


Syed Azim  
Stony Brook University Hospital
Lindsay Stemke  
Stony Brook University Hospital


Pulmonary embolism is a devastating complication of prolonged orthopedic surgery, with an
increased risk in patients with obesity or previous PE. Current guidelines for PE treatment
recommend at least 3 months of NOAC therapy, with suspension 24-48h prior to surgery. We
describe a case in which a 58M with PMH of AF, obesity, and PE, whose rivaroxaban had been
held for 3 days, rapidly desaturated and suffered bradyasystolic arrest while undergoing
extensive thoracolumbar fusion. Intraoperative TEE and postoperative CT confirmed the
presence of PE. We also discuss anticoagulation recommendations in high-risk patients and
consider the utility of perioperative DVT testing.

Professional Category:



Critical Care

Enter up to two references.

1. Desciak MC, Martine DE. (2011 March). Perioperative pulmonary embolism: diagnosis and anesthetic management. Journal of Clinical Anesthesia, 23(2), 153-65.