Management of Subarachnoid Hemorrhage Patients Who Presented With Respiratory Arrest Resuscitated With Bystander CPR

Shapiro, Scott

doi:10.1161/01.str.27.10.1780

Cited by 27 publications

(15 citation statements)

References 8 publications

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“…On the other hand patients experiencing a brief cardiac arrest had GCS of around 8 to 10 [3]. In the study by Shapiro and colleagues patients who experienced a cardiorespiratory arrest had SAH with thick clots and evidence of increased intracerebral pressure [ICP] [16]. Similar findings were presented by Mitsuma and Inamasu, with all CA patients having SAH with Fischer grades of 3 or 4 on CT brain scans [4,10].…”

Section: Resultsmentioning

confidence: 81%

“…Shapiro and colleagues reported 26 cases of patients with SAH with either respiratory or cardiac arrest outside of the hospital [16]. Of these cases, only six patients received chest compressions indicating complete cardiac arrest.…”

Section: Resultsmentioning

confidence: 99%

“…In some cases care was limited to conservative neurosurgical intensive care without surgery [9]. Between 50 to 100% of patients were in some studies treated with clipping [3,16]. In some other studies measures to treat raised intracranial pressure using ventricular drains were taken, but aneurysm surgery was not undertaken due to perceived poor prognosis [8].…”

Section: Resultsmentioning

confidence: 99%

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Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

Skrifvars

Parr

2012

Scand J Trauma Resusc Emerg Med

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IntroductionThe prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH.AimWe reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA.Material and methodsThe following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded.ResultsA total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC.ConclusionCardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation.

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Section: Resultsmentioning

confidence: 81%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

Skrifvars

Parr

2012

Scand J Trauma Resusc Emerg Med

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“…Cardiac arrest resulting from cerebrovascular diseases might also follow respiratory arrest because of damage to the respiratory center in the brainstem. [25][26][27] Therefore, rescue breathing would increase survival after cardiac arrests from cerebrovascular diseases in the same way. In this study, the frequency of initial VF among OHCAs of noncardiac origin was very low (4.1%).…”

Section: Discussionmentioning

confidence: 99%

Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin

et al. 2010

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Background-Although chest compression-only cardiopulmonary resuscitation (CPR) is effective for adult out-ofhospital cardiac arrest (OHCA) of cardiac origin, it remains uncertain whether bystander-initiated rescue breathing has an incremental benefit for OHCA of noncardiac origin. Methods and Results-A nationwide, prospective, population-based, observational study covering the whole population of Japan and involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from January 2005 through December 2007. The primary outcome was neurologically intact 1-month survival. Multiple logistic regression analysis was used to assess the contribution of bystander-initiated CPR to better neurological outcomes. Among a total of 43 246 bystander-witnessed OHCAs of noncardiac origin, 8878 (20.5%) received chest compression-only CPR, and 7474 (17.3%) received conventional CPR with rescue breathing. The conventional CPR group (1.8%) had a higher rate of better neurological outcome than both the no CPR group (1.4%; odds ratio, 1.58; 95% confidence interval, 1.28 to 1.96) and the compression-only CPR group (1.5%; odds ratio, 1.32; 95% confidence interval, 1.03 to 1.69). However, the compression-only CPR group did not produce better neurological outcome than the no CPR group (odds ratio, 1.19; 95% confidence interval, 0.96 to 1.47). The number of OHCAs needed to treat with conventional CPR versus compression-only CPR to save a life with favorable neurological outcome after OHCA was 290. Conclusions-This nationwide observational study indicates that rescue breathing has an incremental benefit for OHCAs of noncardiac origin, but the impact on the overall survival after OHCA was small. (Circulation. 2010;122:293-299.)

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“…Some patients had complete neurological recovery, but most of them resulted in brain death, vegetative state or severe brain damage; and the chance of long term survival is small. [410–12] Patients who receive bystander CPR soon after arrest, those with early return of spontaneous circulation, early diagnosis and appropriate therapy have improved survival. [12]…”

Section: Discussionmentioning

confidence: 99%

Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

Pothiawala

2012

Indian Journal of Critical Care Medicine

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Spontaneous subarachnoid hemorrhage is the most common neurological disorder leading to pre-hospital cardiac arrest. ECG changes in SAH may mimic myocardial infarction or ischemia, and thus lead to delayed treatment of the primary problem. Early identification of SAH-induced cardiac arrest with the use of computed tomography scan of the brain obtained immediately after resuscitation will aid emergency physicians make further decisions. The overall prognosis of patients who are resuscitated is extremely poor. But, prompt neurosurgical referral and multidisciplinary intensive care management can improve the survival rate and the functional outcome. Thus, physicians should consider SAH as a differential diagnosis in patients presenting with pre-hospital cardiac arrest.

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Management of Subarachnoid Hemorrhage Patients Who Presented With Respiratory Arrest Resuscitated With Bystander CPR

Abstract: Aneurysmal SAH patients that present with respiratory arrest present as grade V patients with elevated ICP. Bystander CPR coupled with early retrieval, diagnosis, and therapy can lead to 20% functional survival in what used to be sudden death from aneurysmal SAH.

Cited by 27 publications

References 8 publications

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature

Bystander-Initiated Rescue Breathing for Out-of-Hospital Cardiac Arrests of Noncardiac Origin

Spontaneous subarachnoid hemorrhage as a differential diagnosis of pre-hospital cardiac arrest

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