Traumatic High Cervical Spine Injury Presenting as Cardiac Arrest: A Case Report.

Traumatic high cervical spinal cord injury is a potentially devastating condition that may cause profound cardiovascular and respiratory instability through disruption of descending sympathetic pathways. In severe cases, autonomic dysfunction may contribute to marked hypotension, bradycardia, and cardiac arrest. We report the case of a 47-year-old man who sustained blunt trauma of incompletely characterized mechanism in a workplace accident and was found in cardiac arrest by a prehospital emergency medical team. Advanced life support was initiated, and return of spontaneous circulation was achieved after approximately eight minutes. The documented arrest rhythms included pulseless electrical activity and pulseless ventricular tachycardia. On admission, the patient remained intubated and mechanically ventilated and developed marked hypotension and bradycardia requiring norepinephrine support. Extended focused assessment with sonography for trauma showed no evidence of pneumothorax, pericardial effusion, or free intraperitoneal fluid. Computed tomography revealed a severe C2-C3 distraction injury with intersomatic avulsion, disruption of the posterior ligamentous complex, extensive traumatic hematoma involving the vertebral and spinal canal regions, and associated spinal cord injury. Following multidisciplinary assessment, the injuries were considered irreversible, with no feasible surgical or other outcome-modifying therapeutic option, and care was transitioned to comfort measures. The patient died approximately four and a half hours after admission. This case highlights the potential for severe high cervical spinal cord injury to present with profound autonomic cardiovascular instability and cardiac arrest and emphasizes the importance of considering occult cervical spinal trauma in cases of unexplained cardiorespiratory collapse following major trauma.