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Perioperative safety concerns are a major area of interest in recent years. Severe cardiac perturbation such as cardiac arrest is one of the most dreaded complications in the intraoperative period; however, little is known about the management of these events in the patients undergoing elective neurosurgery. This special group needs further attention, as it is often neither feasible nor appropriate to apply conventional advanced cardiac life support algorithms in patients undergoing neurosurgery. Factors such as neurosurgical procedure and positioning can also have a significant effect on the occurrence of cardiac arrest. Therefore, the aim of this paper is to describe the various causes and management of cardiac emergencies with special reference to cardiac arrest during elective neurosurgical procedures, including discussion of position-related factors and resuscitative considerations in these situations. This will help to formulate possible guidelines for management of such events. 1. Introduction Perioperative safety is a major area of interest in recent years, with increasing emphasis on prevention, management, and outcome of cardiac emergencies. Cardiac arrest is a rare but dreaded intraoperative complication, with an incidence of 1.1 to 7.2 per 10,000 anesthetics [1, 2]. Intraoperative cardiac arrest can lead to devastating outcomes, and there has been renewed interest in its incidence, management, and outcomes [1, 2]. However, the management of intraopera- tive cardiac arrest during neurosurgical procedures remains poorly defined. This topic requires further attention, par- ticularly because it is frequently neither feasible nor appro- priate to apply conventional advanced cardiac life support algorithms (ACLS) during most of the neurosurgical arrests. Chest compressions and defibrillation may be challenging due to surgical positioning or exposure, and furthermore, appropriate management of cardiac arrest in neurosurgical patients may require immediate attention to the underlying cause rather than rote application of the ACLS algorithms. In addition, position and procedure have important effects on the occurrence as well as management of cardiac arrest in neurosurgical patients. Issues related to cardiac defibrillation and resuscitation in patients with skull pin fixation also require further attention. Therefore, this paper is aimed at describing the various causes of cardiac arrest during elective neurosurgical proce- dures, as well as their management. It is also aimed at describ- ing cardiac arrest in the context of neurosurgical positioning and resuscitative management in such situations. Special mention is given to resuscitative methods in patients with skull pin fixation. Finally, an algorithm for the management of cardiac arrest during elective neurosurgery is proposed. 2. Methods 2.1. Eligibility Criteria. Our aim was to identify any study describing management of intraoperative cardiac emergen- cies during elective neurosurgical procedures. Emergent, pediatric ( < 18 y), and obstetrical neurosurgical cases were excluded. 2.2. Definition. We have defined cardiac emergency as any event that includes ventricular fibrillation, pulseless electrical activity, asystole, and severe bradycardia ( < 40/min) with unstable blood pressure. 2.3. Literature Search. Studies were retrieved from Pub Med, Google, EMBASE, SCOPUS, and Web of Science, from 1 January 1970 to 31 May 2013. Searches were C ardiac Emergencies in Neurosurgical Patients Tumul Chowdhury, Andrea Petropolis, and Ronald B. Cappellani FEBRUARY 2022 | The Surgical Technologist | 61