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Cardiac arrest in spontaneous subarachnoid hemorrhage and associated outcomes

Eric Feldstein1, Jose F Dominguez1, Gurkamal Kaur1

  • 11Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.

Neurosurgical Focus
|March 1, 2022
PubMed

Insights

Cardiopulmonary arrest (CA) complicates about 3% of subarachnoid hemorrhage (SAH) cases, leading to very high mortality. However, approximately 18% of patients with CA and SAH may still survive and be discharged with support.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Health Services Research

Background:

  • Subarachnoid hemorrhage (SAH) is a critical neurological condition.
  • Cardiopulmonary arrest (CA) is a known complication of SAH, significantly impacting patient outcomes.
  • Understanding the association between CA and SAH is crucial for improving patient management and survival rates.

Purpose of the Study:

  • To analyze the impact of cardiopulmonary arrest (CA) in patients with subarachnoid hemorrhage (SAH) on short-term outcomes.
  • To investigate mortality and discharge disposition in patients experiencing CA during SAH hospitalization.
  • To identify predictors of mortality and survival in CA-SAH patients.

Main Methods:

  • Retrospective cohort study utilizing de-identified data from the National (Nationwide) Inpatient Sample (NIS).
  • Analysis of 170,869 patients hospitalized with nontraumatic SAH between 2008 and 2014.
  • Comparison of outcomes between patients with and without CA in the context of SAH.

Main Results:

  • 3.2% of SAH patients (5415/170,869) experienced cardiopulmonary arrest (CA).
  • CA-SAH patients had significantly higher mortality rates (82.1% vs. 18.4%) and severity scores (NIS-SSS) compared to non-CA SAH patients.
  • Age, NIS-SSS, and CA were independent predictors of mortality; survival (18%) was associated with chronic conditions and large teaching hospitals.

Conclusions:

  • Cardiopulmonary arrest (CA) is a rare but devastating complication of spontaneous subarachnoid hemorrhage (SAH), associated with extremely high mortality.
  • Despite the grim prognosis, a subset of patients with CA-SAH can survive, with discharge disposition influenced by factors like hospital type and comorbidities.
  • This study highlights the critical need for advanced critical care and targeted interventions for SAH patients who develop CA.
Abstract

Keywords:
SAHcardiac arrestsubarachnoid hemorrhage

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