Lightning strike injuries have a high mortality rate and frequently result in immediate cardiac arrest. Although extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for out-of-hospital cardiac arrest, its role in lightning strike-induced cardiac arrest remains unclear.

We report the case of a 17-year-old male who experienced cardiac arrest after a direct lightning strike. The initial rhythm was non-shockable, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. Return of spontaneous circulation (ROSC) was achieved 81 minutes after the lightning strike. The patient required extensive fluid resuscitation, including blood products, and subsequently developed a pericardial tamponade that required drainage. Despite complications such as compartment syndrome and gastrointestinal bleeding, the patient survived.

This case highlights the potential utility of ECPR in lightning-induced cardiac arrest and the importance of early recognition of pericardial tamponade. Similar to burn management, aggressive fluid resuscitation is critical. Further research is warranted to optimize the treatment protocols for lightning strike victims.