Recovery Against the Odds: A Case Report of Post-Cardiac Arrest Brain Injury Management

Abstract

Background: Post-cardiac arrest brain injury (PCABI) is a major contributor to mortality post-resuscitation. Management involves a multidisciplinary approach focusing on early recognition and aggressive intervention for neurological and cardiac complications. Tools like EEG, CT scan, and MRI aid in assessing neurological impairment. Despite improvements in acute-care treatments, standardized rehabilitation pathways for PCABI are lacking, highlighting the need for ongoing research and patient-centered care strategies.

Case Description: A 22-year-old male presented with ventricular fibrillation and subsequent asystole, leading to witnessed cardiac arrest. Post-resuscitation, he exhibited acute-anoxic encephalopathy (AAE) with a Glasgow Coma Scale (GCS) score of 3/15, requiring intensive care support, including mechanical ventilation and sedation. Initial imaging confirmed hypoxic-ischemic encephalopathy (HIE) and low ejection fraction (EF), which surprisingly improved after a short time interval. Following active neuroprotective therapy, the patient showed signs of cognitive and functional recovery, with improvements in GCS and the ability to perform basic daily activities, though challenges remain in fully assessing long-term outcomes. Neurological complications, such as brain edema and generalized epileptic activity, were managed with pharmacotherapy, while cardiac arrhythmias were treated using antiarrhythmic medications and direct current shocks.

Conclusions: This case underscores the potential for recovery in young patients following cardiac arrest, despite an initial poor prognosis. Early neuroprotective therapy and intensive care support were key in improving cognitive function and daily activities. While long-term outcomes remain uncertain, careful monitoring for neurological and cardiac complications is essential. Clinicians should be aware of the possibility of significant recovery, even in severe hypoxic-ischemic encephalopathy.

Keywords: Cardiac arrest, Coma, Hypoxia-Ischemia, Brain, Electroencephalogram (EEG)