Successful Cardiopulmonary Resuscitation (CPR) Lasting 187 Minutes after Aortic Injury during Nephrectomy

The incidence of "intraoperative cardiac arrest" varies from 1,1-34,6 per 10000 cases. Cardiac arrest due to acute bleeding is the leading cause of death in non-cardiac surgery. Case Report: A 43-year-old female patient, ASA I, was taken to the operating room for laparoscopic left nephrectomy under general anaesthesia. In the 162nd minute of the operation, the surgeon stated that they had injured the aorta at the level of the renal artery and had difficulty stopping the bleeding. At the 165th minute of the operation, the patient had cardiac arrest, and cardiopulmonary resuscitation (CPR) was initiated in the supine position. The patient underwent ventricular fibrillation at the 5th minute of CPR and was defibrillated. In dialogue with the cardiovascular surgeons, surgery was allowed during the interruptions, which did not exceed 1 minute, and then CPR was continued. During the 187 minutes resuscitation, 34 units of erythrocyte suspension, 38 units of fresh frozen plasma,10 of cryoprecipate and 2 pools of platelets were given. When the postoperative neurological condition was assessed after the first 48 hours, the patient was found to be conscious and cooperative. This patient recovered without neurological sequelae after massive blood transfusion and CPR, which lasted for a total of 187 minutes with intermittent manual cardiac compression periods. The outcome of perioperative cardiac arrest depends on factors such as the patient?s baseline condition, the latency to starting CPR, the quality of CPR, and good teamwork.