Recurrent out-of-hospital cardiac arrest (OHCA) in the course of acute coronary syndrome (ACS) in a 43-year-old man: a case report

We report the case of a 43-year-old man with no known cardiac history who developed out-of-hospital cardiac arrest (OHCA) at home, with ventricular fibrillation (VF) as initial rhythm. Following immediate cardiopulmonary resuscitation (CPR) initiated by a bystander under telephone guidance, the emergency medical services (EMS) team provided advanced life support (ALS) in accordance with the 2025 European Resuscitation Council (ERC) guidelines. Multiple transient returns of spontaneous circulation (ROSC) were achieved, interspersed with recurrent cardiac arrest of different mechanisms. Electrocardiographic characteristics of acute coronary syndrome (ACS) were identified after ROSC, and targeted treatment of a potentially reversible cause of cardiac arrest was initiated. Particular emphasis is placed on the organisational aspects of care delivered by a three-person non-physician EMS crew. The operational context included prehospital management in a challenging environment, difficult patient extrication, and prolonged transport to a higher-level referral centre during ongoing resuscitation. These coordinated interventions were associated with short-term survival and allowed definitive in-hospital treatment.