Survival following high-voltage electrical injury with out-of-hospital cardiac arrest: rapid ROSC and full recovery in a resource-limited setting: a case report

BACKGROUND: High-voltage electrical injuries can cause sudden cardiac arrest, most commonly due to ventricular fibrillation, and are associated with high mortality and poor neurological outcomes. Survival with complete neurological recovery following out-of-hospital cardiac arrest remains uncommon, particularly in low-income and resource-limited settings. CASE PRESENTATION: We report the case of a 22-year-old previously healthy male who sustained a high-voltage electrical injury at a construction site and collapsed immediately. On arrival at the emergency department, he was unresponsive, pulseless, and found to be in ventricular fibrillation. Cardiopulmonary resuscitation was initiated promptly, and defibrillation was performed according to advanced cardiac life support protocols, and rapid return of spontaneous circulation was achieved after three cycles of CPR and defibrillation. Post-cardiac arrest care included airway protection, close hemodynamic and neurological monitoring, oxygen supplementation, and active prevention of hyperthermia. Targeted temperature management with induced hypothermia was not performed, as the patient remained normothermic and did not develop a fever. The patient had an uneventful intensive care course and was discharged without neurological deficits. CONCLUSION: This case demonstrates the rare but achievable complete neurological recovery following high-voltage electrical out-of-hospital cardiac arrest presenting with a shockable rhythm, even in resource-limited settings characterized by the absence of a formal prehospital emergency medical service and limited access to advanced post-cardiac arrest interventions such as automated targeted temperature management devices. Favourable outcomes were facilitated by rapid arrival of emergency services enabling prompt rhythm identification, defibrillation with early return of spontaneous circulation, and comprehensive in-hospital post-resuscitation care, including proactive temperature control to maintain normothermia and prevent fever.