Successful prehospital resuscitation of a young female patient with myasthenia gravis experiencing cardiopulmonary arrest due to complete airway obstruction: a case report and review of the literature.

[INTRODUCTION] Patients with myasthenia gravis are at high risk of fatal airway complications due to impaired swallowing mechanics. We present a prehospital resuscitation case involving complete airway obstruction leading to cardiopulmonary arrest in a young patient with myasthenia gravis.

[CASE PRESENTATION] A 21-year-old Han Chinese female patient with a reported history of myasthenia gravis developed sudden respiratory arrest during oral intake. The diagnosis of myasthenia gravis was initially provided by on-scene witnesses (classmates), and later confirmed by family who reported her medication regimen. Prehospital interventions-including modified Heimlich maneuvers, rapid endotracheal intubation, and advanced cardiac life support-achieved return of spontaneous circulation within 10 minutes. Persistent hypoxia and hemodynamic instability were managed during transport. The patient was transferred to the hospital intensive care unit but subsequently died due to the consequences of prolonged cerebral hypoxia.

[DISCUSSION] Myasthenia-gravis-associated bulbar weakness predisposes patients to catastrophic aspiration events. This case highlights three critical prehospital strategies: (1) modified supine-position Heimlich maneuvers for intubated arrest patients, (2) time-critical airway clearance using direct laryngoscopy, and (3) multidisciplinary coordination between telemedicine dispatchers and field responders.

[CONCLUSION] Our findings highlights the unique challenges of managing airway obstruction in patients with myasthenia gravis and proposes an integrated prehospital strategy for airway management. This case underscores that successful prehospital return of spontaneous circulation is possible in patients with myasthenia gravis with acute airway obstruction; however, prevention remains paramount due to the risk of fatal outcomes. It emphasizes the need for integrated prehospital strategies, patient education on aspiration risk, and protocolized airway algorithms for neuromuscular disorders.