A rare form of out-of-hospital cardiopulmonary arrest due to spinal epidural arteriovenous fistula: A case report

Background: A spinal arteriovenous fistula (AVF) can lead to cardiac arrest, but survival from out-of-hospital cardiac arrest (OHCA) has never been reported in the literature. Case presentation: An 84-year-old female called an ambulance because of sudden left hemiparesis. The emergency medical service crew found her in cardiac arrest. Upon hospital arrival, spontaneous circulation returned, and the patient was admitted to intensive care. She regained consciousness after targeted temperature management; however, no limb movements were observed. Since head computed tomography on arrival showed a high-density area at the cervical level, she underwent angiography, which revealed a spinal epidural AVF. Transarterial embolization of the AVF was performed. On day 70, the patient was transferred to a long-term care hospital under mechanical ventilation (cerebral performance category of 1 and modified Rankin Scale of 5). Conclusion: We reported a survival case of OHCA due to ruptured cervical epidural AVF. Optimal management for this condition requires further studies.