Resuscitation to Reperfusion: Full Neurological Recovery in a STEMI Patient Undergoing Extended CPR and Rescue PCI at Madinat Zayed Hospital

Abstract

Acute ST-segment elevation myocardial infarction (STEMI) complicated by cardiac arrest presents a major clinical challenge, especially in resource-limited settings without immediate access to percutaneous coronary intervention (PCI). We report a 37-year-old man with anterior STEMI who suffered prolonged ventricular fibrillation cardiac arrest. After 20 minutes of high-quality CPR and failed thrombolysis at a rural hospital, he was urgently transferred 250 km to a PCI-capable center. Emergent coronary angiography revealed complete proximal left anterior descending artery occlusion, treated successfully with thrombus aspiration and stenting. Comprehensive intensive care, including early antibiotics for aspiration pneumonia, meticulous hemodynamic management, and multidisciplinary rehabilitation, resulted in full neurological recovery. The patient was discharged hemodynamically stable with improving left ventricular function and remained asymptomatic at two-week follow-up. This case underscores the importance of organized regional care networks, adherence to advanced cardiac life support protocols, timely recognition of thrombolysis failure, and prompt transfer for PCI in achieving favorable outcomes in STEMI patients with cardiac arrest. Systems enabling rapid interhospital coordination can significantly improve survival and neurological outcomes, even in geographically isolated settings.