Cardiac arrest after simultaneous release of bilateral tourniquets in lower limb orthopaedic surgery: a case report

Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided