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

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 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report 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 Tekiy Markos Bedore, Ayto Addisu Negash, Amanuel D. Wakoya, Fitsum N. Assefa, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7368280/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Feb, 2026 Read the published version in International Journal of Emergency Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background High-voltage electrical injuries are life-threatening emergencies that can lead to immediate cardiac arrest, most commonly from ventricular fibrillation (VF). Rapid recognition and intervention are critical to improving outcomes, particularly in resource-limited settings. Case Presentation We report the case of a 22-year-old previously healthy male who sustained a high-voltage electrical burn at a worksite located approximately 100 meters from the hospital. He arrived at the Emergency Department unresponsive, pulseless, and in agonal respiration. Cardiac monitoring revealed VF. Immediate cardiopulmonary resuscitation (CPR) and Advanced Cardiac Life Support (ACLS) protocols were initiated, including two defibrillation shocks. Return of spontaneous circulation (ROSC) was achieved after three CPR cycles. The patient was intubated, monitored in the ED, and later transferred to the ICU, where he had an uneventful recovery and was extubated on day five. He was ultimately discharged with full neurological recovery. Discussion This case highlights several key points: the importance of early defibrillation in shockable rhythms such as VF, the potential for favorable outcomes even after prolonged resuscitation efforts, and the role of comprehensive post-cardiac arrest ICU care. It also demonstrates that with rapid response and adherence to ACLS protocols, survival with full recovery is achievable—even in resource-limited settings. Conclusion Early recognition, timely defibrillation, and structured post-resuscitation care can result in complete recovery from electrical injury-induced cardiac arrest. This case reinforces the critical role of immediate intervention and multidisciplinary care in improving outcomes in low resource environments. High-voltage electrical injury ventricular fibrillation out-of-hospital cardiac arrest ACLS ROSC resource-limited setting Figures Figure 1 Introduction Electrical injuries poses significant a unique therapeutic challenges ranging in severity from minor burns to cardiac arrest. Patients in cardiac arrest are managed following standard Advanced Cardiovascular Life Support (ACLS) guidelines [ 1 ]. The success rate of cardiopulmonary resuscitation (CPR) is much higher in this patient population [ 2 ] as they are less likely than the typical cardiac arrest patient to have underlying comorbid conditions. Emergency Medicine and Critical Care European Registry of Cardiac Arrest (EuReCa) project reported that around 25% of all OHCA patients in the European region survive to hospital discharge, and there is significant variation in findings across numerous studies conducted globally [ 3 ]. Survival rates for out-of-hospital cardiac arrest (OHCA) patients are higher when the collapse is witnessed, particularly with bystander CPR [ 4 ]. However, chronic conditions such as kidney disease, heart and respiratory failure, liver cirrhosis, diabetes, malignancies, and hematologic diseases significantly increase hospital mortality rates, with these comorbidities leading to up to three times the risk of fatal outcomes during hospitalization [ 3 ]. During ICU stay, 47–66% of post-OHCA patients die [ 5 ] [ 6 ][ 7 ]. Survivors are typically younger individuals [ 4 , 7 ], with a cardiac etiology for their out-of-hospital cardiac arrest (OHCA) [ 8 ]. They also tend to have a shorter duration of CPR interventions, a greater likelihood of receiving bystander CPR [ 8 ], and a higher incidence of shockable initial heart rhythms [ 8 ]. Additionally, these patients often present with elevated albumin levels [ 9 ] and lower lactate and creatinine levels 4 upon admission. We present a case of a 22-year-old male patient who experienced cardiac arrest following a high-voltage electrical burn. Remarkably, he was discharged from the ICU after five days with no lasting organ damage, making this a rare case report from a low-income country. Case presentation A 22-year-old previously healthy male was brought to the Emergency Department (ED) after sustaining a high-voltage electrical burn while working at a construction site located approximately 100 meters from the hospital. Eyewitnesses reported that the patient had direct contact with a high-tension electrical line through a metallic rod, resulting in immediate collapse. On arrival at the ED, he was unresponsive, exhibiting agonal breathing and no palpable central pulse (carotid). There were no signs of effective circulation. Cardiopulmonary resuscitation (CPR) was initiated immediately, and the resuscitation team was activated without delay. Defibrillator monitor revealed fine ventricular fibrillation, characterized by chaotic, low-amplitude, irregular wide QRS complex (Fig. 1 ). A biphasic defibrillation shock of 200 joules was delivered, followed by a full cycle of CPR. Standard advanced cardiac life support (ACLS) measures were implemented, including opening of airway with jaw thrust maneuver and oral airway insertion and delivering 2 breaths via bag mask ventilation as protocol. Upon rhythm reassessment at the end of the second CPR cycle, VF persisted, and a second biphasic shock of 200 joules was administered. CPR was resumed promptly. During the third cycle, continued resuscitative efforts were maintained per protocol. At the end of the third cycle, rhythm check showed an organized rhythm on the monitor, and both carotid and femoral pulses were palpable, indicating return of spontaneous circulation (ROSC). The patient was immediately intubated for airway protection and placed in the red zone of the emergency department for post-resuscitation care and close hemodynamic monitoring. A physical examination revealed electrical burn injuries with a clearly defined entry wound on the right upper extremity and an exit wound on the plantar surface of the right foot. A non-blanching, whitish wound was noted on the left thigh, involving approximately 4% of total body surface area (TBSA), consistent with a deep partial-thickness (second-degree) burn. Additionally, vesicle-forming wounds were observed on the upper chest and abdomen. Following stabilization in the ED, two intravenous lines were secured, and blood samples were drawn for initial laboratory investigations including complete blood count, electrolytes, cardiac biomarkers, and renal function tests. Fluid resuscitation with normal saline was started. The patient was given tetanus antitoxin (3000 IU intramuscularly), and additional supportive medications were initiated including omeprazole 40 mg IV twice daily, morphine 4 mg IV QID for analgesia, and unfractionated heparin (UFH) 5000 IU subcutaneously BID. Sedation was maintained with ketopropofol infusion, and a nasogastric tube and Foley catheter were placed. The patient was transferred to the intensive care unit (ICU) for continued monitoring and management. He was maintained on mechanical ventilation in CPAP mode and remained hemodynamically stable. On the second ICU Day, he was successfully extubated after demonstrating adequate spontaneous breathing and improved neurological responsiveness. Once clinically stable, the patient was transferred to the plastic surgery ward for specialized wound care and surgical management of his burn injuries. On the fifth hospital day, he underwent a split-thickness skin graft (STSG) to the left thigh. Postoperatively, he received ceftriaxone 1 g IV twice daily for 24 hours, tramadol 50 mg IV three times daily. The graft site was first opened on the eighth hospital day, showing signs of healthy adherence and no signs of infection. Emollient application was initiated as part of routine graft care. The patient continued to improve clinically, and by the fifteenth day of hospitalization, he was discharged home in stable condition, with no neurological deficits and normal vital signs. Discussion High-voltage electrical injuries exceeding 1000 volts are known to cause immediate and potentially fatal arrhythmias, primarily ventricular fibrillation (VF) or asystole. These arrhythmias result from mechanisms such as direct myocardial depolarization, myocardial ischemia, or secondary hypoxia [ 10 ]. In the present case, the initial documented rhythm was VF—an immediately life-threatening but shockable arrhythmia—highlighting the critical importance of early recognition and defibrillation. Favorable neurological outcomes following out-of-hospital cardiac arrest (OHCA) have been reported in similar cases, particularly when several key factors are present: a witnessed arrest, a shockable initial rhythm, and minimal delay in the initiation of resuscitation efforts [ 11 ] [ 2 ]. Our patient's survival and recovery illustrate this, as basic life support (BLS) was initiated promptly, followed by rapid rhythm identification and advanced cardiac life support (ACLS) with successful defibrillation. Early identification and management of VF in high-voltage electrocution are crucial. Literature reports, along with this case, demonstrate that even repeated defibrillation attempts can be effective in achieving return of spontaneous circulation (ROSC) when delivered promptly and according to ACLS protocols [ 2 , 11 ]. Following ROSC, comprehensive post-arrest care plays a central role in determining patient outcomes. This includes airway protection, hemodynamic optimization, and intensive care unit (ICU) monitoring tailored to the electrical injury context [ 12 ] . Continuous cardiac monitoring after ROSC is essential, as delayed arrhythmias have been observed in patients who initially appear stable[ 10 ]. Although the patient’s post-arrest electrocardiogram (ECG) was unremarkable, this finding should not be considered reassuring in isolation. A single normal ECG does not eliminate the risk of subsequent arrhythmogenic complications following electrical trauma [ 13 ]. Electrical injuries may also result in multi-organ dysfunction. Pulmonary complications—including direct thermal injury to lung tissue and non-cardiogenic pulmonary oedema—are well-documented in the literature [ 14 ]. In this case, meticulous ventilatory support and the absence of overt respiratory compromise may have contributed to the patient's uneventful ICU course and timely extubation on day five. Overall, this case supports the growing body of evidence that high-voltage electrical OHCA can result in complete neurological recovery when the arrest is witnessed, the presenting rhythm is shockable, and advanced resuscitative and post-resuscitative care is delivered without delay [ 11 ][ 13 ][ 14 ]. Conclusion This case highlights the critical importance of early recognition, immediate initiation of resuscitative efforts, and adherence to ACLS protocols in the management of high-voltage electrical injuries complicated by out-of-hospital cardiac arrest (OHCA). The successful return of spontaneous circulation (ROSC) after multiple defibrillation attempts and a smooth post-cardiac arrest course, including full neurological recovery, underscores the potential for positive outcomes even in resource-limited settings. Timely intervention, particularly in cases involving shockable rhythms like ventricular fibrillation, plays a pivotal role in survival. This case also reinforces the need for continued vigilance and multidisciplinary care during the post-resuscitation period to prevent delayed complications and optimize recovery. Abbreviations VF Ventricular Fibrillation ACLS Advanced Cardiac Life Support CPR cardiopulmonary resuscitation. ED:Emergency Department ICU Intensive Care Unit OHCA Out of Hospital Cardiac Arrest IHCA In Hospital Cardiac Arrest ROSC Return of Spontaneous Circulation Declarations Ethical approval : Ethical approval is deemed unnecessary by the Institutional Review Board as this is a single, rare case faced during clinical practice, and it does not involve experiments on humans or animals. Consent for publication : Written informed consent was obtained from the patient for publication of this case report and use of images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. Availability of data and materials: N/A Conflict of interest : The authors declare that they have no conflict of interest. Authors Contributions: Tekiy M. Bedore: Involved in patient management, case conceptualization, literature review, original draft writing, and critical revision of the manuscript. Ayto A. Negash: Involved in patient management, case conceptualization, literature review, original draft writing, and critical revision of the manuscript. Amanuel D. Wakoya: Contributed to clinical data collection, literature review, and manuscript editing. Fitsum N. Assefa: Contributed to clinical data collection, literature review, and manuscript editing. Mehreteab T. Woudineh: Contributed to patient care, data review, and critical manuscript feedback. Adey A. Bogale: Contributed to patient care, data review, and critical manuscript feedback. Etsegenet D. Dires: Contributed to data acquisition, literature support, and manuscript editing. Amdela Musema: Contributed to patient care, literature support, and manuscript editing. Acknowledgment : We would like to express our gratitude to the patient for giving us consent to publish this case report. Funding : There is no source of funding for this manuscript. References Morrison M, Woollard M. Outcome of Asymptomatic Electric Shock Victims Requesting an Emergency Ambulance. Prehospital Emerg Care. 2004;8:400–4. https://doi.org/10.1016/j.prehos.2004.05.005 . Motawea M, Al-Kenany AS, Hosny M, Aglan O, Samy M, Al-Abd M. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock. Am J Emerg Med. 2016;34. https://doi.org/10.1016/J.AJEM.2015.06.059 . 679.e1-679.e2. Gräsner JT, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, Koster RW, Masterson S, Rossell-Ortiz F, Maurer H, Böttiger BW, Moertl M, Mols P, Alihodžić H, Hadžibegović I, Ioannides M, Truhlář A, Wissenberg M, Salo A, Escutnaire J, Nikolaou N, Nagy E, Jonsson BS, Wright P, Semeraro F, Clarens C, Beesems S, Cebula G, Correia VH, Cimpoesu D, Raffay V, Trenkler S, Markota A, Strömsöe A, Burkart R, Booth S, Bossaert L. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation. 2020;148:218–26. https://doi.org/10.1016/j.resuscitation.2019.12.042 . Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: A systematic review and meta-analysis. Crit Care. 2020;24. https://doi.org/10.1186/s13054-020-2773-2 . Schober A, Holzer M, Hochrieser H, Posch M, Schmutz R, Metnitz P. Effect of intensive care after cardiac arrest on patient outcome: A database analysis. Crit Care. 2014;18. https://doi.org/10.1186/cc13847 . Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: The relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–80. https://doi.org/10.1007/s00134-013-3043-4 . Nolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K. Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database*. Anaesthesia. 2007;62:1207–16. https://doi.org/10.1111/j.1365-2044.2007.05232.x . Sasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81. https://doi.org/10.1161/CIRCOUTCOMES.109.889576 . Li Y, She Y, Mo W, Jin B, Xiang W, Luo L. Albumin Level at Admission to the Intensive Care Unit Is Associated With Prognosis in Cardiac Arrest Patients, Cureus (2021). https://doi.org/10.7759/cureus.14501 Czuczman AD, Zane RD, Professor E, Daley BJ. Electrical Injuries: A Review For The Emergency Clinician, 2009. Jadhav D, Vijaya L, Alexis J, Pandit V. Survival after prolonged cardiopulmonary resuscitation in cardiac arrest due to electric shock. J Acute Disease. 2018;7:137. https://doi.org/10.4103/2221-6189.236830 . Nikolovski SS, Lazic AD, Fiser ZZ, Obradovic IA, Tijanic JZ, Raffay V. Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors, Cureus (2024). https://doi.org/10.7759/cureus.54827 Corrall S, Laws S, Rice A. Low-voltage electrical injuries and the electrocardiogram: is a ‘normal’ electrocardiogram sufficient for safe discharge from care? A systematic review. Br Paramed J. 2023;8:27–36. https://doi.org/10.29045/14784726.2023.12.8.3.27 . Guimarães F, Camões J, Mesquita A, Gomes E, Araujo R. A Case Report: Low Voltage Electric Injuries Culminating in Cardiac Arrest and Direct Lung Injury, Cureus (2020). https://doi.org/10.7759/cureus.11261 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Feb, 2026 Read the published version in International Journal of Emergency Medicine → Version 1 posted Editorial decision: Revision requested 12 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviews received at journal 01 Dec, 2025 Reviewers agreed at journal 01 Dec, 2025 Reviewers agreed at journal 29 Nov, 2025 Reviews received at journal 05 Oct, 2025 Reviewers agreed at journal 01 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers invited by journal 19 Aug, 2025 Editor assigned by journal 15 Aug, 2025 Submission checks completed at journal 15 Aug, 2025 First submitted to journal 13 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7368280","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":503119310,"identity":"68da1dbd-919f-4798-918b-a223efac7ab1","order_by":0,"name":"Tekiy Markos Bedore","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYFACNoYDYJoHiD8wMCTARHECHmQtjDNQtODQxgOXAGph5iFGiz17W+JhHoZt8uY9hw9/tvlzJ0932uEHDB/KDjPwyzdgt4Xn2AGgltuGc862pUnntj0rNrudZsA449xhBsk2HA6TSG8AaWGcwc9jxpzbcDhx2+0cBmbetsMMBsdwaJF/DtZiD9Ri/NniD1TLX6AWe1xaJNjADkucwdtjIM3ABtXCCLIFV4idSUs4OMfgdvIMnmNpkr1tz4Ba0gwO9pxL55E4loBVC3v7MeMPbypu287gST784cefO0AtyQ8f/CizluNvPoDdGiBg4jGAsw/ASR6c6oGA8QeCjdvgUTAKRsEoGLkAANcwYvV67W4iAAAAAElFTkSuQmCC","orcid":"","institution":"Worabe Comprehensive Specialized Hospital","correspondingAuthor":true,"prefix":"","firstName":"Tekiy","middleName":"Markos","lastName":"Bedore","suffix":""},{"id":503119311,"identity":"2262537e-8abe-4c79-84fa-81dbef871e45","order_by":1,"name":"Ayto Addisu Negash","email":"","orcid":"","institution":"Worabe Comprehensive Specialized Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayto","middleName":"Addisu","lastName":"Negash","suffix":""},{"id":503119312,"identity":"c0da0b87-93a7-476f-9032-d1f9dfc40ed9","order_by":2,"name":"Amanuel D. Wakoya","email":"","orcid":"","institution":"Haromaya university","correspondingAuthor":false,"prefix":"","firstName":"Amanuel","middleName":"D.","lastName":"Wakoya","suffix":""},{"id":503119313,"identity":"52d4c6af-4ef4-4a86-a542-e272e7b2d2d1","order_by":3,"name":"Fitsum N. Assefa","email":"","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Fitsum","middleName":"N.","lastName":"Assefa","suffix":""},{"id":503119314,"identity":"2d71c3ac-d332-4d62-acbd-09547f5851ad","order_by":4,"name":"Mehreteab T. Woudineh","email":"","orcid":"","institution":"St. Paul’s Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mehreteab","middleName":"T.","lastName":"Woudineh","suffix":""},{"id":503119315,"identity":"df5229bd-3cfa-4a19-907c-b2e02f344cea","order_by":5,"name":"Adey A. Bogale","email":"","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Adey","middleName":"A.","lastName":"Bogale","suffix":""},{"id":503119316,"identity":"06b24dc5-9512-44f5-b3f7-90a7dd5e53dd","order_by":6,"name":"Etsegenet D. Dires","email":"","orcid":"","institution":"St. Paul's Hospital Millennium Medical College","correspondingAuthor":false,"prefix":"","firstName":"Etsegenet","middleName":"D.","lastName":"Dires","suffix":""},{"id":503119317,"identity":"9ed6db32-9a21-4f74-984e-252762bd1025","order_by":7,"name":"Amdela Musema","email":"","orcid":"","institution":"Worabe Comprehensive Specialized Hospital","correspondingAuthor":false,"prefix":"","firstName":"Amdela","middleName":"","lastName":"Musema","suffix":""},{"id":503119318,"identity":"d3fa772a-dfe6-4424-8e8f-18a5b2789843","order_by":8,"name":"Mustefa Mohammed Essa","email":"","orcid":"","institution":"Worabe Comprehensive Specialized Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mustefa","middleName":"Mohammed","lastName":"Essa","suffix":""}],"badges":[],"createdAt":"2025-08-13 22:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7368280/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7368280/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12245-026-01136-x","type":"published","date":"2026-02-12T15:59:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89564328,"identity":"c09db7bc-3248-425f-8890-9579ec240419","added_by":"auto","created_at":"2025-08-21 10:33:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92792,"visible":true,"origin":"","legend":"\u003cp\u003eDefibrillator monitor (Mindray BeneHeart D6) displaying fine ventricular fibrillation, characterized by chaotic, low-amplitude, irregular baseline activity without identifiable QRS complexes, in manual mode.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7368280/v1/c3daa397fd6cf613620e6a85.jpeg"},{"id":102785601,"identity":"03b7c188-b806-40d6-a39c-0e351a2c6888","added_by":"auto","created_at":"2026-02-16 16:08:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":532849,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7368280/v1/d4ded19d-0c62-4ca1-a5cb-09ecef2e50ea.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"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","fulltext":[{"header":"Introduction","content":"\u003cp\u003eElectrical injuries poses significant a unique therapeutic challenges ranging in severity from minor burns to cardiac arrest. Patients in cardiac arrest are managed following standard Advanced Cardiovascular Life Support (ACLS) guidelines [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The success rate of cardiopulmonary resuscitation (CPR) is much higher in this patient population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] as they are less likely than the typical cardiac arrest patient to have underlying comorbid conditions. Emergency Medicine and Critical Care European Registry of Cardiac Arrest (EuReCa) project reported that around 25% of all OHCA patients in the European region survive to hospital discharge, and there is significant variation in findings across numerous studies conducted globally [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Survival rates for out-of-hospital cardiac arrest (OHCA) patients are higher when the collapse is witnessed, particularly with bystander CPR [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, chronic conditions such as kidney disease, heart and respiratory failure, liver cirrhosis, diabetes, malignancies, and hematologic diseases significantly increase hospital mortality rates, with these comorbidities leading to up to three times the risk of fatal outcomes during hospitalization [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During ICU stay, 47\u0026ndash;66% of post-OHCA patients die [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e][\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Survivors are typically younger individuals [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], with a cardiac etiology for their out-of-hospital cardiac arrest (OHCA) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. They also tend to have a shorter duration of CPR interventions, a greater likelihood of receiving bystander CPR [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and a higher incidence of shockable initial heart rhythms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Additionally, these patients often present with elevated albumin levels [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and lower lactate and creatinine levels 4 upon admission. We present a case of a 22-year-old male patient who experienced cardiac arrest following a high-voltage electrical burn. Remarkably, he was discharged from the ICU after five days with no lasting organ damage, making this a rare case report from a low-income country.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 22-year-old previously healthy male was brought to the Emergency Department (ED) after sustaining a high-voltage electrical burn while working at a construction site located approximately 100 meters from the hospital. Eyewitnesses reported that the patient had direct contact with a high-tension electrical line through a metallic rod, resulting in immediate collapse. On arrival at the ED, he was unresponsive, exhibiting agonal breathing and no palpable central pulse (carotid). There were no signs of effective circulation.\u003c/p\u003e\u003cp\u003eCardiopulmonary resuscitation (CPR) was initiated immediately, and the resuscitation team was activated without delay. Defibrillator monitor revealed fine ventricular fibrillation, characterized by chaotic, low-amplitude, irregular wide QRS complex (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A biphasic defibrillation shock of 200 joules was delivered, followed by a full cycle of CPR. Standard advanced cardiac life support (ACLS) measures were implemented, including opening of airway with jaw thrust maneuver and oral airway insertion and delivering 2 breaths via bag mask ventilation as protocol. Upon rhythm reassessment at the end of the second CPR cycle, VF persisted, and a second biphasic shock of 200 joules was administered. CPR was resumed promptly. During the third cycle, continued resuscitative efforts were maintained per protocol. At the end of the third cycle, rhythm check showed an organized rhythm on the monitor, and both carotid and femoral pulses were palpable, indicating return of spontaneous circulation (ROSC).\u003c/p\u003e\u003cp\u003eThe patient was immediately intubated for airway protection and placed in the red zone of the emergency department for post-resuscitation care and close hemodynamic monitoring. A physical examination revealed electrical burn injuries with a clearly defined entry wound on the right upper extremity and an exit wound on the plantar surface of the right foot. A non-blanching, whitish wound was noted on the left thigh, involving approximately 4% of total body surface area (TBSA), consistent with a deep partial-thickness (second-degree) burn. Additionally, vesicle-forming wounds were observed on the upper chest and abdomen.\u003c/p\u003e\u003cp\u003eFollowing stabilization in the ED, two intravenous lines were secured, and blood samples were drawn for initial laboratory investigations including complete blood count, electrolytes, cardiac biomarkers, and renal function tests. Fluid resuscitation with normal saline was started. The patient was given tetanus antitoxin (3000 IU intramuscularly), and additional supportive medications were initiated including omeprazole 40 mg IV twice daily, morphine 4 mg IV QID for analgesia, and unfractionated heparin (UFH) 5000 IU subcutaneously BID. Sedation was maintained with ketopropofol infusion, and a nasogastric tube and Foley catheter were placed.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe patient was transferred to the intensive care unit (ICU) for continued monitoring and management. He was maintained on mechanical ventilation in CPAP mode and remained hemodynamically stable. On the second ICU Day, he was successfully extubated after demonstrating adequate spontaneous breathing and improved neurological responsiveness.\u003c/p\u003e\u003cp\u003eOnce clinically stable, the patient was transferred to the plastic surgery ward for specialized wound care and surgical management of his burn injuries. On the fifth hospital day, he underwent a split-thickness skin graft (STSG) to the left thigh. Postoperatively, he received ceftriaxone 1 g IV twice daily for 24 hours, tramadol 50 mg IV three times daily.\u003c/p\u003e\u003cp\u003eThe graft site was first opened on the eighth hospital day, showing signs of healthy adherence and no signs of infection. Emollient application was initiated as part of routine graft care. The patient continued to improve clinically, and by the fifteenth day of hospitalization, he was discharged home in stable condition, with no neurological deficits and normal vital signs.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHigh-voltage electrical injuries exceeding 1000 volts are known to cause immediate and potentially fatal arrhythmias, primarily ventricular fibrillation (VF) or asystole. These arrhythmias result from mechanisms such as direct myocardial depolarization, myocardial ischemia, or secondary hypoxia [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the present case, the initial documented rhythm was VF\u0026mdash;an immediately life-threatening but shockable arrhythmia\u0026mdash;highlighting the critical importance of early recognition and defibrillation.\u003c/p\u003e\u003cp\u003eFavorable neurological outcomes following out-of-hospital cardiac arrest (OHCA) have been reported in similar cases, particularly when several key factors are present: a witnessed arrest, a shockable initial rhythm, and minimal delay in the initiation of resuscitation efforts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Our patient's survival and recovery illustrate this, as basic life support (BLS) was initiated promptly, followed by rapid rhythm identification and advanced cardiac life support (ACLS) with successful defibrillation.\u003c/p\u003e\u003cp\u003eEarly identification and management of VF in high-voltage electrocution are crucial. Literature reports, along with this case, demonstrate that even repeated defibrillation attempts can be effective in achieving return of spontaneous circulation (ROSC) when delivered promptly and according to ACLS protocols [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Following ROSC, comprehensive post-arrest care plays a central role in determining patient outcomes. This includes airway protection, hemodynamic optimization, and intensive care unit (ICU) monitoring tailored to the electrical injury context [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] .\u003c/p\u003e\u003cp\u003eContinuous cardiac monitoring after ROSC is essential, as delayed arrhythmias have been observed in patients who initially appear stable[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although the patient\u0026rsquo;s post-arrest electrocardiogram (ECG) was unremarkable, this finding should not be considered reassuring in isolation. A single normal ECG does not eliminate the risk of subsequent arrhythmogenic complications following electrical trauma [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eElectrical injuries may also result in multi-organ dysfunction. Pulmonary complications\u0026mdash;including direct thermal injury to lung tissue and non-cardiogenic pulmonary oedema\u0026mdash;are well-documented in the literature [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this case, meticulous ventilatory support and the absence of overt respiratory compromise may have contributed to the patient's uneventful ICU course and timely extubation on day five.\u003c/p\u003e\u003cp\u003eOverall, this case supports the growing body of evidence that high-voltage electrical OHCA can result in complete neurological recovery when the arrest is witnessed, the presenting rhythm is shockable, and advanced resuscitative and post-resuscitative care is delivered without delay [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e][\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the critical importance of early recognition, immediate initiation of resuscitative efforts, and adherence to ACLS protocols in the management of high-voltage electrical injuries complicated by out-of-hospital cardiac arrest (OHCA). The successful return of spontaneous circulation (ROSC) after multiple defibrillation attempts and a smooth post-cardiac arrest course, including full neurological recovery, underscores the potential for positive outcomes even in resource-limited settings. Timely intervention, particularly in cases involving shockable rhythms like ventricular fibrillation, plays a pivotal role in survival. This case also reinforces the need for continued vigilance and multidisciplinary care during the post-resuscitation period to prevent delayed complications and optimize recovery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVentricular Fibrillation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACLS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdvanced Cardiac Life Support\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ecardiopulmonary resuscitation. ED:Emergency Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOHCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOut of Hospital Cardiac Arrest\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIHCA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIn Hospital Cardiac Arrest\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eROSC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eReturn of Spontaneous Circulation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e: Ethical approval is deemed unnecessary by the Institutional Review Board as this is a single, rare case faced during clinical practice, and it does not involve experiments on humans or animals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Written informed consent was obtained from the patient for publication of this case report and use of images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eN/A\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u0026nbsp;\u003c/strong\u003eTekiy M. Bedore: Involved in patient management, case conceptualization, literature review, original draft writing, and critical revision of the manuscript. Ayto A. Negash: Involved in patient management, case conceptualization, literature review, original draft writing, and critical revision of the manuscript. Amanuel D. Wakoya: Contributed to clinical data collection, literature review, and manuscript editing. Fitsum N. Assefa: Contributed to clinical data collection, literature review, and manuscript editing. Mehreteab T. Woudineh: Contributed to patient care, data review, and critical manuscript feedback. Adey A. Bogale: Contributed to patient care, data review, and critical manuscript feedback. Etsegenet D. Dires: Contributed to data acquisition, literature support, and manuscript editing. Amdela Musema: Contributed to patient care, literature support, and manuscript editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e: We would like to express our gratitude to the patient for giving us consent to publish this case report.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: There is no source of funding for this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorrison M, Woollard M. Outcome of Asymptomatic Electric Shock Victims Requesting an Emergency Ambulance. Prehospital Emerg Care. 2004;8:400\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.prehos.2004.05.005\u003c/span\u003e\u003cspan address=\"10.1016/j.prehos.2004.05.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMotawea M, Al-Kenany AS, Hosny M, Aglan O, Samy M, Al-Abd M. Survival without sequelae after prolonged cardiopulmonary resuscitation after electric shock. Am J Emerg Med. 2016;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/J.AJEM.2015.06.059\u003c/span\u003e\u003cspan address=\"10.1016/J.AJEM.2015.06.059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 679.e1-679.e2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGr\u0026auml;sner JT, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I, Koster RW, Masterson S, Rossell-Ortiz F, Maurer H, B\u0026ouml;ttiger BW, Moertl M, Mols P, Alihodžić H, Hadžibegović I, Ioannides M, Truhl\u0026aacute;ř A, Wissenberg M, Salo A, Escutnaire J, Nikolaou N, Nagy E, Jonsson BS, Wright P, Semeraro F, Clarens C, Beesems S, Cebula G, Correia VH, Cimpoesu D, Raffay V, Trenkler S, Markota A, Str\u0026ouml;ms\u0026ouml;e A, Burkart R, Booth S, Bossaert L. Survival after out-of-hospital cardiac arrest in Europe - Results of the EuReCa TWO study. Resuscitation. 2020;148:218\u0026ndash;26. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.resuscitation.2019.12.042\u003c/span\u003e\u003cspan address=\"10.1016/j.resuscitation.2019.12.042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: A systematic review and meta-analysis. Crit Care. 2020;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13054-020-2773-2\u003c/span\u003e\u003cspan address=\"10.1186/s13054-020-2773-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchober A, Holzer M, Hochrieser H, Posch M, Schmutz R, Metnitz P. Effect of intensive care after cardiac arrest on patient outcome: A database analysis. Crit Care. 2014;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/cc13847\u003c/span\u003e\u003cspan address=\"10.1186/cc13847\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, Carli P, Mira JP, Nolan J, Cariou A. Intensive care unit mortality after cardiac arrest: The relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00134-013-3043-4\u003c/span\u003e\u003cspan address=\"10.1007/s00134-013-3043-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K. Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database*. Anaesthesia. 2007;62:1207\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2044.2007.05232.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2044.2007.05232.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSasson C, Rogers MAM, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63\u0026ndash;81. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1161/CIRCOUTCOMES.109.889576\u003c/span\u003e\u003cspan address=\"10.1161/CIRCOUTCOMES.109.889576\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Y, She Y, Mo W, Jin B, Xiang W, Luo L. Albumin Level at Admission to the Intensive Care Unit Is Associated With Prognosis in Cardiac Arrest Patients, Cureus (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.14501\u003c/span\u003e\u003cspan address=\"10.7759/cureus.14501\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCzuczman AD, Zane RD, Professor E, Daley BJ. Electrical Injuries: A Review For The Emergency Clinician, 2009. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003cspan address=\"http://www.guideline.gov\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJadhav D, Vijaya L, Alexis J, Pandit V. Survival after prolonged cardiopulmonary resuscitation in cardiac arrest due to electric shock. J Acute Disease. 2018;7:137. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/2221-6189.236830\u003c/span\u003e\u003cspan address=\"10.4103/2221-6189.236830\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNikolovski SS, Lazic AD, Fiser ZZ, Obradovic IA, Tijanic JZ, Raffay V. Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors, Cureus (2024). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.54827\u003c/span\u003e\u003cspan address=\"10.7759/cureus.54827\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorrall S, Laws S, Rice A. Low-voltage electrical injuries and the electrocardiogram: is a \u0026lsquo;normal\u0026rsquo; electrocardiogram sufficient for safe discharge from care? A systematic review. Br Paramed J. 2023;8:27\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.29045/14784726.2023.12.8.3.27\u003c/span\u003e\u003cspan address=\"10.29045/14784726.2023.12.8.3.27\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuimar\u0026atilde;es F, Cam\u0026otilde;es J, Mesquita A, Gomes E, Araujo R. A Case Report: Low Voltage Electric Injuries Culminating in Cardiac Arrest and Direct Lung Injury, Cureus (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.11261\u003c/span\u003e\u003cspan address=\"10.7759/cureus.11261\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"High-voltage electrical injury, ventricular fibrillation, out-of-hospital cardiac arrest, ACLS, ROSC, resource-limited setting","lastPublishedDoi":"10.21203/rs.3.rs-7368280/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7368280/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHigh-voltage electrical injuries are life-threatening emergencies that can lead to immediate cardiac arrest, most commonly from ventricular fibrillation (VF). Rapid recognition and intervention are critical to improving outcomes, particularly in resource-limited settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report the case of a 22-year-old previously healthy male who sustained a high-voltage electrical burn at a worksite located approximately 100 meters from the hospital. He arrived at the Emergency Department unresponsive, pulseless, and in agonal respiration. Cardiac monitoring revealed VF. Immediate cardiopulmonary resuscitation (CPR) and Advanced Cardiac Life Support (ACLS) protocols were initiated, including two defibrillation shocks. Return of spontaneous circulation (ROSC) was achieved after three CPR cycles. The patient was intubated, monitored in the ED, and later transferred to the ICU, where he had an uneventful recovery and was extubated on day five. He was ultimately discharged with full neurological recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights several key points: the importance of early defibrillation in shockable rhythms such as VF, the potential for favorable outcomes even after prolonged resuscitation efforts, and the role of comprehensive post-cardiac arrest ICU care. It also demonstrates that with rapid response and adherence to ACLS protocols, survival with full recovery is achievable—even in resource-limited settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly recognition, timely defibrillation, and structured post-resuscitation care can result in complete recovery from electrical injury-induced cardiac arrest. This case reinforces the critical role of immediate intervention and multidisciplinary care in improving outcomes in low resource environments.\u003c/p\u003e","manuscriptTitle":"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","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 10:33:32","doi":"10.21203/rs.3.rs-7368280/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-12T11:23:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T20:43:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-01T21:17:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"64315448254522437180792257072300657134","date":"2025-12-01T17:52:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263837772742514616919288416402775752491","date":"2025-11-30T02:09:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T04:32:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180843016242872605395739954181474886196","date":"2025-10-01T13:17:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205042768581219697117822479347809313720","date":"2025-09-29T21:45:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-20T01:00:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-15T04:47:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-15T04:46:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2025-08-13T22:02:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f43964ee-60ab-416b-ae37-54aa25938f51","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T16:06:59+00:00","versionOfRecord":{"articleIdentity":"rs-7368280","link":"https://doi.org/10.1186/s12245-026-01136-x","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2026-02-12 15:59:07","publishedOnDateReadable":"February 12th, 2026"},"versionCreatedAt":"2025-08-21 10:33:32","video":"","vorDoi":"10.1186/s12245-026-01136-x","vorDoiUrl":"https://doi.org/10.1186/s12245-026-01136-x","workflowStages":[]},"version":"v1","identity":"rs-7368280","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7368280","identity":"rs-7368280","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}