Catastrophic Bone Cement Implantation Syndrome Identified Real Time with Transesophageal Echocardiography

Characterized by unexpected hypoxia, hypotension, or hemodynamic collapse, bone cement implantation syndrome (BCIS) is a rare complication of orthopedic surgeries. During the process of utilizing cement to aid in prosthetic implantation, increased intramedullary pressure can lead to embolization of mixed contents (cement, fat, air,) into the heart. By mechanical obstruction and inflammatory response, BCIS can lead to catastrophic cardiovascular collapse. Herein, we present an 81-year-old man with grade three BCIS with pulseless electrical activity during a left hip arthroplasty with the aid of transesophageal echocardiography.