Clinical Manifestations of BCIS

Bone Cement Implantation Syndrome (BCIS) presents with a wide range of clinical manifestations, from mild to life-threatening. Mild cases may involve transient hypotension and hypoxia, while more severe manifestations include cardiac arrhythmias and, in extreme instances, cardiac arrest. These symptoms are often attributed to right ventricular failure due to increased pulmonary vascular resistance (PVR). The rise in PVR dilates the right ventricle, shifting the interventricular septum towards the left, which reduces left ventricular compliance. This reduction leads to a decrease in left ventricular filling and cardiac output (CO). While the underlying causes of the increase in PVR remain unclear, potential contributors include the absorption of volatile cement monomers and the deposition of emboli, such as fat or bone marrow, in the pulmonary circulation. Clinical indicators, including a sudden decrease in end-tidal CO2 (ETCO2), are strong signs of BCIS, but a definitive diagnosis requires imaging, such as a computed tomography (CT) scan.