Complete Recovery After Prolonged Cardiac Arrest With Manual CPR and Low-Contrast PCI.

BACKGROUND

Out-of-hospital cardiac arrest due to asystole carries a poor prognosis, particularly in resource-limited settings.

CASE SUMMARY: This report describes complete neurologic and hemodynamic recovery in a 48-year-old man after out-of-hospital cardiac arrest due to asystole. Treatment strategies included early targeted temperature management, 53 minutes of uninterrupted cardiopulmonary resuscitation (CPR), intracardiac adrenaline (1 mg), and ultra-low contrast percutaneous coronary intervention (PCI).

WHY BEYOND THE GUIDELINES: Current guidelines do not define CPR duration for asystole, nor do they recommend intracardiac adrenaline, endorse manual cooling, or support ultra-low contrast PCI without intravascular imaging or circulatory support.

DISCUSSION: Targeted temperature management (34-36 °C) was initiated using intravenous cold saline, gastric infusion, and surface ice packs. Return of spontaneous circulation followed 53 minutes of resuscitation, including 1 mg of intracardiac adrenaline. A completely occluded left anterior descending artery was revascularized in 7 minutes using 9 mL of diluted contrast.

TAKE-HOME MESSAGE: This case highlights the feasibility of full recovery from prolonged asystolic arrest using manual CPR, bedside cooling, and contrast-sparing PCI in a peripheral, resource-limited setting.