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Published on: May 28, 2019
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Complete Recovery After Prolonged Cardiac Arrest With Manual CPR and Low-Contrast PCI
1Global Cardiac Centre, Adimali, Kerala, India; Government TD Medical College Alappuzha, Alappuzha, Kerala, India.
JACC. Case Reports
|August 15, 2025
Summary
Full recovery from prolonged asystolic cardiac arrest is possible with early targeted temperature management, extended cardiopulmonary resuscitation (CPR), and minimally invasive procedures. This case demonstrates effective treatment in resource-limited settings.
Area of Science:
- Cardiology
- Emergency Medicine
- Critical Care
Background:
- Out-of-hospital cardiac arrest (OHCA) due to asystole has a poor prognosis, especially in resource-limited environments.
- Current guidelines lack specific recommendations for CPR duration in asystole and do not endorse certain advanced interventions.
Observation:
- A 48-year-old male presented with OHCA and asystole.
- Treatment involved early targeted temperature management (TTM), 53 minutes of continuous cardiopulmonary resuscitation (CPR), intracardiac adrenaline, and ultra-low contrast percutaneous coronary intervention (PCI).
Findings:
- The patient achieved complete neurologic and hemodynamic recovery.
- Return of spontaneous circulation occurred after 53 minutes of resuscitation, including 1 mg of intracardiac adrenaline.
- A severely occluded artery was successfully treated with minimal contrast (9 mL) via PCI.
Implications:
- This case demonstrates the feasibility of achieving full recovery from prolonged asystolic arrest.
- Manual CPR, bedside cooling, and contrast-sparing PCI are viable strategies in peripheral, resource-limited settings.
- Highlights potential for advanced interventions outside traditional guidelines in critical situations.
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