Wang Ya-Dong, Lin Jin-Feng, Cao Zhi-Long, Zhang Su-Yan, Han Xu-Dong
Department of Critical Care Medicine, Nantong Third People's Hospital, Nantong, China.
Medicine (Baltimore). 2025 Jan 31;104(5):e41298. doi: 10.1097/MD.0000000000041298.
Cardiac arrest (CA) is a life-threatening event with a high mortality rate, and neurological injury following cardiopulmonary resuscitation (CPR) is a leading cause of death and disability in survivors. While prolonged CPR is often associated with poor neurological outcomes, there is limited evidence of successful recovery following extended resuscitation efforts. This study aims to highlight the potential for recovery after prolonged CPR by reporting a case of a patient who underwent 152 minutes of CPR, regained consciousness, and made a full recovery. The purpose is to explore whether advanced life-support techniques, such as extracorporeal CPR (ECPR), can improve survival and neurological outcomes even after prolonged CA.
A 53-year-old man with no prior health issues experienced sudden CA while exercising and underwent prolonged CPR.
Restoration of spontaneous circulation following CA and ventricular fibrillation.
ECPR, target temperature management, continuous renal replacement therapy, and intracranial pressure management.
Immediate recovery: following the restoration of spontaneous circulation, the patient was immediately transferred to the intensive care unit for further treatment. Despite the prolonged CPR duration, the patient remained hemodynamically stable and was able to tolerate the intensive interventions. Neurological recovery: after 1 week of intensive therapy, the patient regained consciousness. Initially, there was some confusion and disorientation, but he gradually became fully alert, oriented, and communicative. Neurological assessments indicated no significant long-term deficits, and brain imaging showed no signs of irreversible damage. Cardiological and renal recovery: cardiac function was closely monitored, with no evidence of significant ischemic damage to the myocardium. The patient's renal function improved with continuous renal replacement therapy, and kidney function returned to normal following the discontinuation of dialysis. Discharge: after 2 weeks of treatment in the intensive care unit and a transfer to the cardiology department for rehabilitation, the patient was discharged from the hospital. He had fully recovered both neurologically and physiologically, with no residual deficits.
This case demonstrates that prolonged CPR, when combined with advanced interventions such as ECPR, can result in favorable outcomes, including survival and neurological recovery. The findings suggest that with timely and appropriate treatment, even patients with extended resuscitation efforts may achieve full recovery, thus underscoring the potential of ECPR as a critical life-saving intervention in cases of prolonged CA.
心脏骤停（CA）是一种危及生命的事件，死亡率很高，心肺复苏（CPR）后的神经损伤是幸存者死亡和残疾的主要原因。虽然长时间的心肺复苏通常与不良的神经学预后相关，但延长复苏努力后成功恢复的证据有限。本研究旨在通过报告一例接受了152分钟心肺复苏、恢复意识并完全康复的患者，强调长时间心肺复苏后恢复的可能性。目的是探讨体外心肺复苏（ECPR）等高级生命支持技术是否即使在长时间心脏骤停后也能改善生存率和神经学预后。
一名53岁无既往健康问题的男性在运动时突然发生心脏骤停，并接受了长时间的心肺复苏。
心脏骤停和心室颤动后恢复自主循环。
体外心肺复苏、目标温度管理、持续肾脏替代治疗和颅内压管理。
即刻恢复：自主循环恢复后，患者立即被转至重症监护病房进行进一步治疗。尽管心肺复苏时间延长，但患者血流动力学保持稳定，能够耐受强化干预措施。神经学恢复：经过1周的强化治疗，患者恢复意识。最初，患者有一些意识模糊和定向障碍，但逐渐完全清醒、定向并能够交流。神经学评估显示无明显长期缺陷，脑部影像学检查未显示不可逆损伤迹象。心脏和肾脏恢复：密切监测心脏功能，无心肌明显缺血损伤证据。患者肾功能通过持续肾脏替代治疗得到改善，透析停止后肾功能恢复正常。出院：在重症监护病房治疗2周并转至心脏科进行康复治疗后，患者出院。他在神经学和生理学上均已完全康复，无残留缺陷。
该病例表明，长时间心肺复苏与体外心肺复苏等高级干预措施相结合，可产生良好的结果，包括生存和神经学恢复。研究结果表明，通过及时和适当的治疗，即使是复苏时间延长的患者也可能实现完全康复，从而强调了体外心肺复苏在长时间心脏骤停病例中作为关键的挽救生命干预措施的潜力。
