Cardiac arrest after tourniquet deflation in tibial plateau fracture surgery in a healthy man

Surgical tourniquets are commonly used in orthopedic and trauma surgery. Although the pneumatic tourniquet has been classified by the US Food and Drug Administration as a class I medical device, there are still reports of hazards related to its use. Here, we describe an unusual complication experienced by a healthy man after he underwent surgery for trauma to the lower extremity. The patient experienced cardiac arrest 5 minutes after tourniquet release and was resuscitated immediately. He regained consciousness without any symptoms, and the electrocardiographic signs of arrhythmia completely resolved within 30 minutes of leaving the operating room. The patient recovered completely and was discharged 5 days later. The mechanism underlying the incidence of cardiac arrest after tourniquet deflation is still not clear. By ruling out other common intraoperative triggers as possibilities and upon reviewing the literature, we conclude that reperfusion injury is a plausible and the most likely explanation. Injuries resulting from tourniquet use are commonly pressure-related, and can also be caused by excessive tourniquet time. To reduce these injuries, an adequate pressure set-up (a cuff pressure not exceeding 300 mmHg) and tourniquet ischemia time less than 2 hours should always be the preferred option. Even then, it may be impossible to eliminate all associated complications.