Abstract
Hypoxic encephalopathy due to prolonged cardiopulmonary arrest is associated with poor neurological prognosis, often leading to significant impairment in activities of daily living (ADL) and social reintegration. Rehabilitation for patients experiencing cardiac arrest lasting over 15 minutes is rarely successful. This case report describes a 29-year-old male patient with hypoxic encephalopathy following a 19-minute cardiopulmonary arrest while in a sauna, who achieved substantial ADL recovery through intensive acute-phase rehabilitation. Cardiopulmonary resuscitation (CPR) was initiated 13 minutes after collapse, and ventricular fibrillation was identified six minutes later by an automated external defibrillator (AED) and successfully treated with a single defibrillation. On arrival at the hospital, laboratory findings revealed metabolic acidosis and myocardial dysfunction, with an ejection fraction of 35%. The patient had a history of Wolff-Parkinson-White (WPW) syndrome. Brain MRI with diffusion-weighted imaging (DWI) showed high signal intensity in the occipital lobe and medial thalamus, leading to a diagnosis of hypoxic encephalopathy. The patient's initial neurological assessment indicated severe impairment, with a Glasgow Coma Scale (GCS) score of E4/VT/M6, a modified Rankin Scale (mRS) score of 5, and a Cerebral Performance Category (CPC) score of 4. He experienced generalized seizures requiring continuous anticonvulsant therapy. Rehabilitation was initiated on hospital day (HD) 3 but was discontinued on HD 15 due to poor consciousness. It was resumed on HD 27 after neurological improvement. The rehabilitation strategy focused on short-interval, high-frequency interventions, beginning with postural control exercises and passive range of motion therapy. As the patient's muscle strength improved, wheelchair mobility training and standing exercises were introduced. Gait training commenced with a body-weight support walker on HD 67, transitioning to long-leg orthotic therapy and progressive gait exercises. By HD 123, the patient's lower limb muscle strength improved from Manual Muscle Testing (MMT) grade 1 to 4, and the Barthel Index (BI) score increased from 0 to 45. He was able to walk 50 meters with light assistance and perform ADLs with minimal support. The patient was subsequently transferred to a rehabilitation hospital for further recovery. His significant recovery was attributed to early and intensive rehabilitation, which prevented disuse syndrome and facilitated neuroplasticity. Short-duration, high-frequency interventions played a crucial role in improving cardiovascular endurance, maintaining musculoskeletal function, and supporting cognitive recovery. The use of assistive devices, particularly long-leg orthoses, was instrumental in facilitating ambulation by compensating for lower limb weakness. Additionally, interdisciplinary collaboration, including occupational therapy and nursing interventions, played a critical role in optimizing functional outcomes. Despite prolonged cardiopulmonary arrest and an initially severe neurological prognosis, the patient demonstrated remarkable functional recovery, challenging conventional expectations. Thus, structured and intensive physiotherapy may significantly improve functional outcomes, even in patients with initially poor prognostic indicators.