Abstract
Out-of-hospital cardiac arrest (OHCA) is associated with low survival and neurologic recovery rates, especially when return of spontaneous circulation exceeds 45 minutes. Additionally, neurologic prognostic indicators, such as absent brainstem reflexes and presence of alpha coma electroencephalogram (EEG) patterns, are typically associated with poor outcomes. This report outlines the case of a 48-year-old woman with a history of hypertension, dyslipidemia, and tobacco use who suffered an OHCA due to an acute left anterior descending artery occlusion. She experienced a total downtime of 53 minutes and required multiple rounds of defibrillation and advanced cardiac life support. Following successful percutaneous coronary intervention, her initial neurologic examination remained poor with absent brainstem reflexes, nonreactive pupils, and EEG findings consistent with severe encephalopathy. After 22 days in the hospital with minimal neurologic improvement, she was discharged to long-term care with a tracheostomy and percutaneous endoscopic gastrostomy tube. Two months after initial discharge, the patient unexpectedly returned to the hospital, demonstrating signs of cognitive recovery. During this second hospital stay, she was alert, followed commands, was able to communicate using a voice modulator, and passed a swallow study. This case illustrates a rare example of survival after prolonged OHCA and subsequent neurologic improvement following an initially guarded prognosis.