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Cardiorespiratory arrest in aneurysmal subarachnoid hemorrhage

M Ramirez-Lassepas1, A Ahmed

  • 1From the Department of Neurology and Stroke Service, St. Paul-Ramsey Medical Center, St. Paul, and the Department of Neurology, University of Minnesota, Minneapolis, MN, U.S.A.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|October 22, 2015
PubMed

Insights

Cardiorespiratory arrest (CRA) is a significant risk in aneurysmal subarachnoid hemorrhage (ASAH). Despite successful resuscitation (SR), outcomes for patients experiencing CRA remain poor, indicating limited influence of SR on prognosis.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Aneurysmal subarachnoid hemorrhage (ASAH) is a life-threatening condition often leading to cardiorespiratory arrest (CRA).
  • Successful resuscitation (SR) offers a chance for diagnosis and treatment in ASAH survivors.
  • The incidence of CRA and the impact of SR on ASAH prognosis require further investigation.

Purpose of the Study:

  • To determine the incidence of cardiorespiratory arrest (CRA) in patients with aneurysmal subarachnoid hemorrhage (ASAH).
  • To evaluate the influence of successful resuscitation (SR) on the prognosis of ASAH patients who experience CRA.

Main Methods:

  • Retrospective review of hospital records for 95 consecutive ASAH patients diagnosed between 1980 and 1988.
  • Data collection included symptoms, aneurysm location, treatment, clinical course, and outcomes.
  • Literature review was conducted to supplement findings.

Main Results:

  • 16% of ASAH patients experienced CRA, more common in women with posterior circulation aneurysms (PCA) and intracerebral-ventricular clot (ICC).
  • Patients with CRA were clinically Stage V; only 7% survived hospitalization.
  • For patients without CRA, 56% survived hospitalization.
  • Among patients hospitalized after out-of-hospital SR, 7% with ASAH survived.

Conclusions:

  • Cardiorespiratory arrest (CRA) is a frequent and serious complication of aneurysmal subarachnoid hemorrhage (ASAH).
  • The prognosis for ASAH patients experiencing CRA is extremely poor and is not significantly improved by successful resuscitation (SR).
  • Large initial hemorrhages disrupting brainstem centers are the likely cause of CRA in ASAH.

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