Abstract 18812: Clinical and Cardiac Features in Patients Showing Out-of-Hospital Cardiac Arrest After Subarachnoid Hemorrhage
Background: Subarachnoid hemorrhage (SAH) has been known as one of the etiologies of out-of-hospital cardiac arrest (OHCA). However, the detailed clinical features of these patients remain unknown.
Methods and Results: We examined 244 consecutive OHCA patients transferred to our emergency department. Head computed tomography (CT) was performed on all patients and revealed the existence of SAH in 14 of 244 patients (5.9%, 10 female). Among them, sudden collapse was witnessed in 8 patients (57%). Of note, on their initial cardiac rhythm recorded by emergency medical service, 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 SAH patients. The ROSC rate in patients with SAH (71%) was significantly higher than those of patients with either another type of intracranial hemorrhage (25%) or presumed cardiovascular etiologies (22%) (p<0.01, Table). Electrocardiograms and echocardiograms were performed in SAH patients after ROSC. ST-T abnormalities and/or QT prolongation were found in all 10 ROSC patients. Large ST segment depression in widespread leads with aVR ST elevation, like severe myocardial ischemia, was observed in 6 patients. Despite their various electrocardiographic abnormalities, only 3 of 10 patients had echocardiographic abnormalities; Takotsubo-like regional wall motion abnormalities were found in all 3 patients. All 10 patients with ROSC died of brain death (Table).
Conclusions: The frequency of SAH in OHCA was about 6%. The initial cardiac rhythm recorded by emergency medical service revealed no Vf despite a high incidence of the existence of witness. The high ROSC rate was observed in patients showing OHCA with SAH, although their survival rate and neurological outcome were poor. These findings may help clarify the mechanism of sudden cardiac arrest in SAH.
- © 2010 by American Heart Association, Inc.