2026 FSA Podium and Poster Abstracts

Introduction: Electromagnetic-guided feeding tube placement is frequently performed in critically ill and perioperative patients and is generally considered low risk. However, manipulation of the upper airway, esophagus, and stomach can provoke intense vagal stimulation, resulting in severe bradycardia and, in rare cases, cardiac arrest. This risk may be heightened in anesthetized patients, in whom early symptoms are not apparent. We present a case of intraoperative cardiac arrest during electromagnetic-guided feeding tube placement attributed to a vagal-mediated mechanism.

Methods: A critically ill adult patient with multiple medical comorbidities underwent surgery under general anesthesia. Due to anticipated prolonged postoperative ventilatory support, intraoperative placement of an electromagnetic-guided enteral feeding tube was planned. The patient was hemodynamically stable prior to tube placement, with continuous electrocardiographic and invasive blood pressure monitoring in place. During advancement of the feeding tube, abrupt hemodynamic changes were observed. The intraoperative course, resuscitative measures, and subsequent clinical outcome were reviewed.

Results: During advancement of the feeding tube, the patient developed sudden profound bradycardia that rapidly progressed to asystole. Tube advancement was immediately stopped, and cardiopulmonary resuscitation was initiated. Atropine and epinephrine were administered in accordance with Advanced Cardiac Life Support (ACLS) guidelines. Return of spontaneous circulation was achieved within minutes. No hypoxia, electrolyte abnormality, or anesthetic-related cause was identified. The event was attributed to an exaggerated vagal response triggered by esophageal and gastric stimulation during tube placement. The patient stabilized hemodynamically and was transferred to the intensive care unit for continued management.

Discussion: This case highlights a rare but serious complication associated with electromagnetic-guided feeding tube placement. The esophagus and stomach are richly innervated by the vagus nerve, and mechanical stimulation can elicit marked parasympathetic responses, particularly in patients with limited physiologic reserve. Under general anesthesia, the absence of warning symptoms allows bradycardia to progress rapidly. This case underscores the importance of vigilance during feeding tube advancement, prompt cessation of the procedure at the first sign of hemodynamic instability, and immediate readiness to initiate resuscitative measures. Consideration of prophylactic anticholinergic therapy and heightened monitoring may be warranted in high-risk patients.