Ureteroscopic laser lithotripsy under spinal anesthesia has been common in clinical practice nowadays. We report a case of cardiac arrest during ureteroscopic laser lithotripsy. The patient was resuscitated successfully and recovered well. We consider that venous air embolism (VAE) is the most probable cause of the cardiac arrest, and remind anesthesiologists and urologists to increase vigilance on this fatal complication when performing ureteroscopic procedures. Rapid initiation of CPR and uninterrupted chest compression seem to be effective in case of catastrophic VAE with cardiac arrest occurred.