Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 01 01 341 344 Mahmoud Mohammed ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Eriks Sliders ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. Shanavaskhan Shamsudeenkutty Cardiology Department, Al Dhafra Zayed Hospital, United Arab Emirates. Ashraf Alakkad Internal Medicine Department, Madinat Zayed Hospital, SEHA, United Arab Emirates. Mostafa Saleh ICU Department, Madinat Zayed Hospital, AlDhafra Western Region, SEHA, United Arab Emirates. & Critical Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October, Egypt. Mohamed Abd Elrahman Internal Medicine Department, CMO Sila Hospital, Abu Dhabi, United Arab Emirates. 2025 07 01 2025 07 09 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. https://aacc.tums.ac.ir/index.php/aacc/article/view/1332