Survival After Out-of-Hospital Cardiac Arrest and 85-Minute Resuscitation.

Refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest is associated with high mortality, particularly when resuscitation is prolonged. Early cardiopulmonary resuscitation (CPR), rapid defibrillation, and comprehensive post-return of spontaneous circulation (ROSC) care are critical determinants of survival. A 46-year-old previously healthy man collapsed during exercise. Immediate bystander CPR was initiated. Emergency medical services identified VF as the initial rhythm and delivered multiple defibrillation shocks along with antiarrhythmic therapy. On hospital arrival, the patient remained in persistent VF, and advanced cardiac life support was continued. ROSC was achieved after prolonged resuscitation but was followed by a brief re-arrest. Sustained ROSC occurred after a total CPR duration of approximately 85 minutes, during which 20 defibrillation shocks were administered. Advanced airway management and pharmacologic therapy, including epinephrine, amiodarone, lidocaine, and magnesium, were provided. Following ROSC, the patient developed severe hemodynamic instability requiring mechanical ventilation, intravenous fluids, and high-dose vasopressors. Electrocardiography demonstrated diffuse ST-segment depression with subtle ST-segment elevation in leads aVR, aVL, and V1, suggestive of an acute ischemic etiology. Neurological examination revealed preserved brainstem reflexes. Active temperature control was initiated, and the patient was transferred for urgent coronary angiography and management in the coronary care unit. Coronary angiography confirmed complete proximal left anterior descending artery occlusion, and primary percutaneous coronary intervention with drug-eluting stent implantation was performed. The subsequent hospital course was complicated by cardiogenic shock, complete atrioventricular block requiring temporary transvenous pacing, and recurrent ventricular tachycardia/ventricular fibrillation triggered by frequent premature ventricular complexes with an R-on-T pattern. Repeat coronary angiography confirmed a patent left anterior descending artery (LAD) stent with TIMI (Thrombolysis in Myocardial Infarction) III flow. The patient survived and achieved good neurological recovery, with a Glasgow Coma Scale score of 15/15 after extubation. This case illustrates survival after prolonged resuscitation for refractory VF, emphasizing the importance of early bystander CPR, persistent advanced life support, urgent coronary revascularization, careful rhythm management, and comprehensive post-cardiac arrest care. In selected patients, extended resuscitative efforts may result in meaningful survival despite prolonged cardiac arrest.