From Sudden Death to Recovery: a Case Report on the Challenges of Out Of-Hospital Resuscitation and Its Complications

Introduction Out-of-hospital resuscitation for sudden cardiac arrest, guided by EMS, often leads to complex complications challenging post-resuscitation care. [1] This rare success story underscores these challenges, as the patient fully recovered despite clinical death, bystander CPR, and severe complications. Case Presentation A 56-year-old man experienced out-of-hospital cardiac arrest (OHCA) at home, with cardiopulmonary resuscitation (CPR) initiated by bystanders. Paramedics identified ventricular fibrillation and restored circulation via defibrillation. On hospital admission, inferior ST-elevation myocardial infarction (STEMI) was diagnosed, and successful primary percutaneous coronary intervention of the left circumflex artery was performed. Nevertheless, the patient's condition remained critical: he presented with impaired consciousness, coma with the Glasgow Coma Scale 5 (GCS 5), cardiogenic shock, and development of early-onset pneumonia. CPRrelated trauma included liver rupture with acute liver failure, rib and vertebral fractures, haemothorax, and haemoperitoneum. Moderate anoxic coma (GCS 6) and later critical illness polyneuropathy were diagnosed. ICU management included mechanical ventilation for 31 days, sedation, tracheostomy, and treatment of hospital-acquired pneumonia with reserve antibiotics—C-reactive protein was 364 mg/L, procalcitonin 34 μg/L. Despite OHCA’s low survival rate, the patient's condition stabilized after 41 ICU days, followed by rehabilitation, achieving full cognitive recovery and discharge with good overall somatic status. Discussion Compared to in-hospital resuscitation, bystander CPR poses a higher risk of injury due to untrained rescuers and delayed advanced care. Although, bystander CPR improves the survival rate of OHCA, in such cases only 10 % of patients survive, often requiring prolonged intensive care with high mortality. Better dispatcher guidance and public training could reduce these risks. [2,3,4] Conclusions Early bystander CPR is vital for restoring circulation in OHCA but often leads to complications, requiring ICU care to manage organ dysfunction, neurological damage, and trauma-related injuries, improving short- and long-term outcomes.