Bone Cement Implantation Syndrome Causing Intraoperative Cardiac Arrest in a Nonagenarian: A Case Report.

Bone cement implantation syndrome (BCIS) is a rare but potentially fatal complication of cemented orthopedic procedures, most commonly hip hemiarthroplasty in elderly patients. It is characterized by acute cardiovascular and respiratory compromise that can progress to cardiac arrest. We present the case of a 90-year-old woman with long-standing hypertension who sustained a left intertrochanteric femoral fracture following a fall. She was scheduled for cemented hemiarthroplasty and underwent spinal anesthesia. Approximately five minutes after insertion of polymethylmethacrylate bone cement, she developed profound hypoxia, severe hypotension, and bradycardia, which rapidly progressed to cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated immediately, including intubation, mechanical ventilation with 100% oxygen, intravenous adrenaline, and advanced life support measures. Return of spontaneous circulation was achieved after four cycles of high-quality CPR, and the procedure was completed successfully. Postoperatively, she required intensive care with vasopressor support and mechanical ventilation but was gradually stabilized, extubated, and discharged home in good condition. This case underscores the life-threatening potential of BCIS, the importance of early recognition, and the critical role of timely multidisciplinary resuscitative interventions in determining survival and functional recovery.