Related Experiment Video

Updated: Jan 22, 2026

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

Published on: August 30, 2020

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Cardiac Arrest in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Single-Center Experience

Sami Ridwan1,2, Rudolf Kristof1,3

  • 1Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.

Journal of Neurological Surgery. Part A, Central European Neurosurgery
|July 5, 2019
PubMed

Insights

Patients with severe subarachnoid hemorrhage (SAH) grade 5 can survive, even with cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). These patients should still be considered for neurosurgical treatment despite poorer outcomes.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Poor-grade aneurysmal subarachnoid hemorrhage (SAH), particularly Hunt and Hess (H&H) grade 5, has a high fatality rate.
  • Limited research exists on the outcomes of H&H grade 5 SAH patients, especially concerning comorbidities like cardiac arrest (CA) requiring cardiopulmonary resuscitation (CPR).

Purpose of the Study:

  • To assess the clinical outcomes of patients with SAH H&H grade 5.
  • To determine the influence of additional CA and CPR on the outcomes of these patients.

Main Methods:

  • Retrospective analysis of 80 patients with SAH H&H grade 5 admitted between 2001 and 2010.
  • Data extraction from hospital records and electronic databases.
  • Clinical outcome assessment using Glasgow Outcome Score and modified Rankin Scale (mRS); analysis of CA and CPR impact.

Main Results:

  • Mortality was 85% in patients with CA versus 68% without CA (p=0.158).
  • Of 59 patients without CA, 4 had good outcomes (mRS 0-3). Of 21 patients with CA, none had good outcomes (mRS 4-5).
  • Aneurysm occlusion and posterior circulation aneurysms were associated with better outcomes (p<0.001 and p=0.010, respectively).

Conclusions:

  • SAH H&H grade 5 patients can survive, with a small percentage achieving good outcomes.
  • While CA and CPR were associated with less favorable outcomes, statistical significance was not reached.
  • SAH H&H grade 5 patients, regardless of CA/CPR status, should not be excluded from neurosurgical interventions.
Abstract

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