Evaluation of non-traumatic intracranial hemorrhages as cause of cardiac arrest in emergency department

Abstract

Aim: Cardiac arrests can be brought to emergency departments with an intervention from out-of hospital, and they can also occur for different reasons in the emergency department. Due to the high rates of mortality in this important clinical situation, regulations are made through guidelines and algorithms. Most of these regulations cover acute coronary syndromes and special conditions. The aim of our study is to evaluate intracranial hemorrhages in non-traumatic cardiac arrest cases in our emergency department for a period of 10 years. Material and Method: The data of patients 18 years of age and over who were found to have cardiac arrest in the emergency department between January 2011 and January 2021, who did not have trauma, were retrospectively scanned from the hospital information management system. Demographic information of all patients, computed tomography examinations for intracranial hemorrhage and emergency department outcomes were evaluated. Results: Of the 173 patients included in the study, 81 (46.8%) were women. The median age of the patients was determined as 72.00 (IQR 64.00-80-00). In the whole patient group, 20 (11.6%) patients had intracranial bleeding and 10 of these patients were women. More intrcranial hemorrhage was detected in the group that underwent CT before cardiopulmonary resuscitation (CPR) and it was statistically significant (p<0.001). In 4% of the patients who underwent CT after CPR, intracranial bleeding was detected. No difference was found in terms of the presence of bleeding or the timing of tomography in terms of discharge from the hospital. Conclusion: With this study, we found the rate of intracranial hemorrhage (ICH) to be 11.6% in patients with in-hospital cardiac arrest. As changes occur in the treatment and management of patients in the presence of ICH, we think that brain CT should be performed in the early period in cardiac arrest cases of unknown cause, as stated in the guidelines. Especially in the presence of change in consciousness and high blood pressure, it is important to organize algorithms in order to detect ICH.