Survival Without Neurological Sequelae Following Massive Pulmonary Embolism and Prolonged Cardiac Arrest

Abstract

We present the case of a 17-year-old female who survived cardiac arrest caused by a massive pulmonary embolism leading to obstructive shock. Despite a prolonged low-flow period of 193 minutes, she fully recovered without apparent neurological damage, thanks to immediate cardiopulmonary resuscitation (CPR) initiated by her father, timely intervention by paramedics and medical teams, and the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Key factors in her recovery included the absence of a no-flow period, maintenance of end-tidal CO 2 (ETCO 2 ) levels above 25-30 mmHg during resuscitation, and the vital role of VA-ECMO in supporting organ perfusion. This case highlights the importance of prompt bystander intervention, continuous ETCO 2 monitoring during CPR, and the integration of advanced circulatory support measures in post-cardiac arrest care. Additionally, it underscores the potential for favorable neurological outcomes even after extended resuscitation, provided there is adequate cerebral perfusion and timely mechanical support. The report emphasizes the need for public education on basic life support (BLS).