Elsevier

Resuscitation

Volume 82, Issue 10, October 2011, Pages 1294-1297
Resuscitation

Clinical paper
Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2011.05.019Get rights and content

Abstract

Background

Subarachnoid haemorrhage (SAH) is known as one of the aetiologies of out-of-hospital cardiac arrest (OHCA). However, the mechanisms of circulatory collapse in these patients have remained unclear.

Methods and results

We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography was performed on all patients and revealed the existence of SAH in 14 patients (5.9%, 10 females). Among these, sudden collapse was witnessed in 7 patients (50%). On their initial cardiac rhythm, all 14 patients showed asystole or pulseless electrical activity, but no ventricular fibrillation (VF). Return of spontaneous circulation (ROSC) was obtained in 10 of the 14 patients (14.9% of all ROSC patients) although all resuscitated patients died later. The ROSC rate in patients with SAH (71%) was significantly higher than that of patients with either other types of intracranial haemorrhage (25%, n = 2/8) or presumed cardiovascular aetiologies (22%, n = 23/101) (p < 0.01). On electrocardiograms, ST-T abnormalities and/or QT prolongation were found in all 10 resuscitated patients. Despite their electrocardiographic abnormalities, only 3 patients showed echocardiographic abnormalities.

Conclusions

The frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF even though half had a witnessed arrest. A high ROSC rate was observed in patients with SAH, although none survived to hospital discharge.

Introduction

Stroke is a cause of cardiac arrest (CA). American Heart Association (AHA)/American Stroke Association guidelines emphasize that stroke is an impending condition leading to CA.1, 2 Death from subarachnoid haemorrhage (SAH) is often sudden and different from that of ischemic stroke and other types of intracranial haemorrhage (ICH).3, 4, 5 SAH is known to be one of the causes of out-of-hospital cardiac arrest (OHCA).5, 6 Some reports showed that SAH accounts for 4–10% of all OHCA.6, 7, 8 On the other hand, SAH is often accompanied with abnormal cardiac findings, such as electrocardiographic and echocardiographic abnormalities and increased cardiac enzymes.9 The mechanisms leading to CA after SAH have remained unclear, and cardiac findings of resuscitated patients have hardly been discussed before. In this study, we examined clinical and cardiac features of patients with OHCA after SAH.

Section snippets

Study population

The study protocol was reviewed and accepted by the local ethics committee of Niigata University Department of Medicine. We investigated patients with OHCA who arrived at the emergency department of Niigata University Medical and Dental Hospital, a tertiary referral center covering a local population of approximately 800,000, from April 2007 to June 2009. Cardiopulmonary resuscitation (CPR) for OHCA victims is performed in accordance with the Basic/Advanced Cardiac Life Support guidelines of

The clinical features of SAH in OHCA

During this study period, 244 patients with OHCA were transferred to our emergency department, and 67 patients (27%) achieved ROSC. Spontaneous SAH, other types of ICH, and presumed cardiovascular aetiology were identified as the cause of CA in 14, 8, and 101 patients, respectively. SAH was found in 5.7% of all OHCA. Clinical characteristics of SAH patients with OHCA are shown in Table 1, Table 2. The mean age was 67 years (aged 32–84). A tendency of female dominance in SAH was observed in

Discussion

In this study, we found 4 major findings: (1) in patients with OHCA after SAH, the initial cardiac rhythm recorded by emergency medical service revealed no VF even though half had a witnessed arrest, (2) the frequency of SAH in all ROSC patients was about 15%, (3) there was a high ROSC rate in SAH patients although their survival rate and neurological outcome were poor, and (4) various cardiac findings were documented in SAH patients after ROSC.

Previously, some reports suggested that SAH is one

Conclusions

In conclusion, the frequency of SAH in patients with all causes of OHCA was about 6%, and in resuscitated patients was about 15%. The initial cardiac rhythm revealed no VF despite the high incidence of witnessed collapse. A high ROSC rate was observed but their outcomes were poor in patients with SAH.

Conflict of interest statement

None.

Acknowledgement

This study was supported in part by THE TSUKADA GRANT FOR NIIGATA UNIVERSITY MEDICAL RESEARCH.

References (24)

  • American Heart Association

    Heart diseases and stroke statistics – 2005 update

    (2004)
  • L.H. Phillips et al.

    Sudden death from stroke

    Stroke

    (1977)
  • Cited by (0)

    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.05.019.

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