Background and Purpose: The sudden death rate from aneurysmal subarachnoid hemorrhage (AH) is 10%. Since 1989, 26 SAH patients who are were witnessed to collapse into coma with respiratory arrest and required cardiopulmonary resuscitation (CPR) at the scene survived to reach the hospital and be diagnosed. Although reports hospital management of grade V AH suggest issue arrest after acute SAH. We analyzed our experienced with this unique subgroup of aneurysmal SAH patients. Methods: This is a retrospective analysis of 26 consecutive AH patients who collapsed at the scene and required CPR for respiratory arret and survived to reach the hospital and be diagnose. Statistical analysis was performed using the t test and Mann- whitney rank-sum test. Result: All patients were grad V on arrival at the emergency department. Twenty-one patients received mouth-to-mouth resuscitation only, and 5 received chest compression a well. The mean duration of bystander CPR was 12 to 15 minute. CT scan showed diffuse, thick SAH in all patient, an associated subdural hemorrhage in 2 and an intraparenchymal hemorrhage in 4. After CT scan, an intracranial pressure (ICP) monitor was placed in 24, and 2 were taken to emergency surgery for subdural and intracerebral hemorrhage. ICP was elevated in 24 patients (mean 54 mm Hg), and a ventriculostomy was placed in all 24. ICP was unreponive in 12, and all suffered brain death. ICP lessened to <25 mm Hg in 12, and all underwent angiography. All 12 had an aneurysm and underwent emergency surgical clipping. Time to surgery from SAH was ≤ 11 hours in all 12 patients. All were managed with calcium channel block and hyperdynamic therapy in addition to aggressive control of ICP. The outcome at 12 month in the 14 surgical cases was normal in 3 patients (21%), good in 2 (14%) vegetative in 1 (7%), and death in 8 (57%). Conclusions: Aneurysmal SAH patients that present with respiratory arrest present as grade V patients with elevated ICP. Bystanders CPR coupled with early retrieval diagnosis and therapy can lead to 20% functional survival in what used to be sudden death from aneurysmal SAH.
- cardiopulmonary resuscitation
- subarachnoid hemorrhage
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine