200 Section - Integrated Early and Outpatient Cardiopulmonary Rehabilitation in a Post–Sudden Cardiac Arrest Survivor: A Case Report

Case Diagnosis: A 29-year-old male suffered out-of-hospital sudden cardiac arrest (SCA). He was resuscitated with immediate CPR and defibrillation, followed by the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Coronary angiography revealed moderate left ventricular (LV) dysfunction (LVEF 37%) with patent coronary arteries. Persistent low cardiac output required sequential support from an intra-aortic balloon pump (IABP) and an Impella device. Genetic testing identified pathogenic variants in BAG3 and OBSCN, suggesting an inherited predisposition to cardiomyopathy.

Case Description: Following stabilization, ventilator weaning, and removal of mechanical support, the patient began Phase I cardiopulmonary rehabilitation during his hospitalization, including both ICU and ward settings. The program focused on early mobilization, breathing exercise, and functional training. To prevent recurrent ventricular tachyarrhythmias, an implantable cardioverter-defibrillator (ICD) was placed prior to discharge. Subsequently, the patient transitioned to a 4-week Phase II outpatient program, consisting of supervised moderate-to-high intensity aerobic exercise (50–70% heart rate reserve) and progressive resistance training (50–70% 1RM) five times per week.

Discussions: After one month, cardiopulmonary exercise testing (CPET) demonstrated a VO₂max of 46.2 mL/kg/min (104.3% predicted), a ventilatory threshold of 28.2 mL/kg/min, and a VE/VCO2 slope of 25.8, without arrhythmias or ICD activation. Follow-up echocardiography showed LVEF recovery to 57.6%. These results demonstrate the patient attained a fitness level surpassing age-predicted norms. Such high ventilatory efficiency suggests that intensive exercise facilitates profound physiological recovery despite complex mechanical support and genetic substrates.

Conclusions: This case illustrates the safety and feasibility of achieving exceptional functional recovery via integrated inpatient-to-outpatient rehabilitation for an SCA survivor requiring multiple circulatory supports. Attaining high aerobic capacity without adverse events supports the safety profile of including structured rehabilitation as a standard component of post-arrest care. This approach is essential for optimizing long-term cardiovascular health in high-risk populations.