Successful lipid rescue therapy after prolonged cardiac arrest in acute cocaine intoxication

A 24-year-old male experienced cardiac arrest following a generalized seizure shortly after being stopped at a border control. Paramedics administered intranasal midazolam, after which the patient became asystolic and underwent prolonged cardiopulmonary resuscitation. The patient had a history of cocaine abuse. Suspected acute cocaine intoxication prompted the administration of intravenous lipid emulsion (ILE). Shortly thereafter, the rhythm converted to ventricular fibrillation and return of spontaneous circulation occurred 80 min after the arrest. No underlying cause was identified on diagnostic imaging or coronary angiography. Toxicological testing confirmed markedly elevated cocaine levels, consistent with body stuffing. Despite initial stabilization in the intensive care unit (ICU), the patient developed multiorgan failure and progressive cerebral edema leading to malignant intracranial hypertension. The patient died within 24 h of admission. This case highlights the potentially fulminant course of cocaine toxicity and suggests that lipid emulsion therapy may be considered as an early rescue intervention in refractory cocaine-induced cardiac arrest when conventional treatment fails.