Key result
A 16-minute PEA arrest precedes refractory cardiogenic shock and cerebellar infarction in cocaine-associated end-stage HF.
Why the study?
In end-stage HFrEF patients with PEA arrest, refractory shock frequently dominates outcomes despite post-resuscitation encephalopathy prompting early neurologic prognostication.
Case Report (n=1)
No
In patients with end-stage HFrEF and PEA arrest, refractory hemodynamic collapse often predominates over neurologic injury, requiring an integrated framework for goals-of-care discussions.
No takes yet. Share an insight, caveat, or question.
Supports integrated goals-of-care framework when hemodynamic collapse predominates after PEA in end-stage HFrEF; hypothesis-generating for post-resuscitation research.
Pulseless electrical activity (PEA) arrest in patients with end-stage heart failure with reduced ejection fraction (HFrEF) most commonly reflects profound circulatory collapse rather than a primary arrhythmogenic event. Although post-resuscitation encephalopathy often prompts early neurologic prognostication, myocardial dysfunction and refractory shock frequently dominate outcomes in this population. We report the case of a 59-year-old woman with end-stage HFrEF, severe multivessel coronary artery disease, chronic lung disease, HIV infection, and active cocaine use who presented with acute hypoxic respiratory failure and decompensated heart failure and subsequently developed prolonged PEA arrest. Her post-arrest course was complicated by refractory cardiogenic shock, focal cerebellar infarction with delayed MRI due to hemodynamic instability and vasopressor dependence, and multisystem organ failure. Taken together, these findings underscore an important post-resuscitation diagnostic pitfall: neurologic abnormalities may coexist; however, refractory hemodynamic collapse often predominates. An integrated framework incorporating shock physiology, substance-associated cardiotoxicity, and competing neurologic injury is essential for accurate clinical assessment and informed goals-of-care discussions.
Chiriboga et al. (2026) conducted a case report in End-stage heart failure with reduced ejection fraction and cocaine-associated cardiotoxicity (n=1). A 59-year-old woman with end-stage heart failure (ejection fraction 10%) and cocaine use developed refractory cardiogenic shock and a concurrent cerebellar infarction following a 16-minute PEA arrest.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: