Successful Resuscitation From Intraoperative Cardiac Arrest Due to Massive Hemorrhage During Oncologic Abdominal Surgery: A Case Report From a Resource-Limited Setting

Abstract

Intraoperative cardiac arrest is a rare but catastrophic perioperative emergency. Massive hemorrhage is an important reversible cause during major oncologic surgery, where continuous monitoring permits immediate recognition and cause-directed resuscitation. A 46-year-old male weighing 57 kg with a height of 162 cm, classified as ASA physical status III, underwent elective exploratory laparotomy, tumor debulking, and Miles procedure for recurrent pelvic spindle cell sarcoma. Preoperative assessment revealed approximately 15 kg of weight loss over one year, hemoglobin of 9.3 g/dL, and leukocyte count of 22,200/µL, without significant cardiopulmonary abnormalities. Because major blood loss was anticipated, invasive monitoring, central venous access, and packed red cells, platelets, and fresh frozen plasma were prepared preoperatively. During tumor debulking, sudden hemodynamic collapse progressed to cardiac arrest secondary to massive surgical hemorrhage. High-quality cardiopulmonary resuscitation, aggressive volume replacement, and blood-product transfusion were initiated immediately while surgical hemorrhage control was performed. Return of spontaneous circulation was achieved within minutes. The patient was transferred to the intensive care unit, recovered without neurological deficits, and was discharged home in stable condition. Early recognition of hemorrhagic hypovolemia, immediate cardiopulmonary resuscitation, concurrent volume and blood-product replacement, hemorrhage control, and rapid mobilization of available resources contributed to successful resuscitation. Hemorrhage-related intraoperative cardiac arrest may result in favorable neurological recovery when the reversible cause is rapidly identified and treated concurrently with high-quality cardiopulmonary resuscitation and coordinated multidisciplinary management.