Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: A prospective computed tomography study

Inamasu, Joji; Miyatake, Satoru; Tomioka, Hideto; Suzuki, Mitsuaki; Nakatsukasa, Masashi; Maeda, Naoki; Ito, Takeshi; Arai, Koji; Komura, Masayoshi; Kase, Kenichi; Kobayashi, Kenji

doi:10.1016/j.resuscitation.2009.05.010

Cited by 80 publications

(65 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5,12) Previously, 7% to 11% of SAH patients presented with CPA, [8][9][10] compatible with our finding of 11% of SAH patients presenting with CPA. The outcomes of resuscitated SAH-CPA patients remain extremely poor despite recent progress in the treatment of ruptured cerebral aneurysms.…”

Section: Discussionsupporting

confidence: 90%

“…[8][9][10] In most patients, the initial cardiac rhythm is non-shockable, i.e., either asystole or pulseless electrical activity, both of which develop after severe hypoxic insult. 5) Nevertheless, some long-term survivors of SAH-CPA are known. 2,3,17,18) The reported long-term survival rate of SAH-CPA patients in case series ranges from 1.6% to 13%.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Return of spontaneous circulation (ROSC) is more easily established in patients with CPA caused by SAH, compared with CPA of cardiac origin. [5][6][7] However, brain functions do not recover despite successful resuscitation in the great majority of SAH-CPA patients. Consequently, vigorous therapeutic intervention to prevent aneurysmal rebleeding has usually been withheld because of the poor outcomes resulting from irreversible brain damage.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Subarachnoid Hemorrhage Causing Cardiopulmonary Arrest: Resuscitation Profiles and Outcomes

Inamasu

Nakagawa

Kuramae

et al. 2011

Neurol. Med. Chir.(Tokyo)

Self Cite

View full text Add to dashboard Cite

Aneurysmal subarachnoid hemorrhage (SAH) is a common cause of cardiopulmonary arrest (CPA). The outcomes of SAH patients presenting with CPA are extremely poor, and long-term survivors have occasionally been reported, but the circumstances under which SAH-CPA patients achieve long-term survival are unclear. Neurosurgeons will have to determine whether a SAH-CPA patient is brain-dead or not more often after enactment of the revised Organ Transplantation Act. Prediction of survival length may be important not only to neurosurgeons, but also to the transplantation team. A retrospective study was conducted to elucidate how often brainstem function was recovered in resuscitated SAH-CPA patients and whether the recovery was associated with longer survival. Among 315 patients with nontraumatic SAH admitted to our institution during 6 years, 35 (11%) presented with CPA. Ventricular fibrillation (VF) as initial cardiac rhythm was rare, observed only in 1 patient. The survival length ranged from 1 to 15 days (mean 3.5 ± 0.7 days), and none achieved long-term survival. Return of brainstem function, represented by spontaneous respiration and/or reactive pupils, was observed in 6 patients (17%), but was only partial and transient. Cardiac arrest to return of spontaneous circulation interval tended to be shorter in patients with transient recovery of the brainstem function than in those without recovery. However, the survival length was not significantly different between the two groups. In addition to the 35 SAH-CPA patients, another 44 SAH patients lost both brainstem reflexes and spontaneous respiration within 72 hours of admission. As a result, 79 (25%) of the 315 SAH patients were considered to have sustained fatal, irreversible brain damage. Review of previous experience suggests that SAH-CPA patients may survive only if the cause of cardiac arrest is VF and not brainstem damage/respiratory arrest. Approximately one-third of resuscitated SAH-CPA patients may die within 24 hours of arrival, for whom the declaration of brain death may be difficult.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Subarachnoid Hemorrhage Causing Cardiopulmonary Arrest: Resuscitation Profiles and Outcomes

Inamasu

Nakagawa

Kuramae

et al. 2011

Neurol. Med. Chir.(Tokyo)

Self Cite

View full text Add to dashboard Cite

show abstract

“…16) Although these two complications had been regarded as separate entities in the past, 18,35) recent studies indicate that they share a common pathophysiology and may coexist in the same patient. 12,20,21,24,31) The common pathophysiology involves massive catecholamine release, particularly norepinephrine, into the circulation immediately after aneurysm rupture, and is responsible for endothelial damage, vasoconstriction, and increased vascular permeability. 7,20,21) However, how often SAH patients complicated with NPE also have concomitant TCM (NPE-TCM) remains unclear, since evaluation of cardiac wall motion using transthorac-…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, SAH patients complicated with TCM may not always sustain NPE. 12) The incidence of pulmonary edema in patients with TCM unrelated to SAH is low (22%), 33) suggesting that NPE may not necessarily be a consequence of TCM.…”

mentioning

confidence: 99%

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Inamasu

Nakatsukasa

Mayanagi

et al. 2012

Neurol. Med. Chir.(Tokyo)

Self Cite

View full text Add to dashboard Cite

Patients with poor-grade subarachnoid hemorrhage (SAH) are often complicated with acute cardiopulmonary dysfunctions, particularly neurogenic pulmonary edema (NPE) and takotsubo-like cardiomyopathy (TCM). This study retrospectively investigated the incidence, demographics, clinical characteristics, and outcomes of patients with SAH complicated with both NPE and TCM (NPE-TCM). The effects of aneurysm location and other clinical variables on the incidence of NPE-TCM were also investigated. Among 234 SAH patients treated during 5-year period, 16 (7%) presented with NPE, and transthoracic ultrasonography revealed that 14 of these 16 patients (88%) also had TCM. All 14 patients with NPE-TCM had poor-grade SAH (World Federation of Neurosurgical Societies grades IV and V). Ruptured posterior circulation aneurysm was predictive of NPE-TCM, but other clinical variables were not. Eight of the 14 patients with NPE-TCM could undergo treatment for ruptured aneurysm. Long-term outcomes were favorable in 5 of the 8 patients. Grade IV SAH patients had significantly better outcomes than grade V patients. TCM develops frequently in SAH patients presenting with NPE, and transthoracic ultrasonography should be conducted routinely in that population. Patients with ruptured posterior circulation aneurysm may have elevated risk of developing NPE-TCM. Endovascular obliteration of the aneurysm may be preferable to open surgery, but the optimal treatment modality needs to be evaluated further. Considering the limited number of SAH patients complicated with NPE-TCM, a multi-center cooperative study may be required.

show abstract

Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury

et al. 2016

View full text Add to dashboard Cite

Subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest: A prospective computed tomography study

Cited by 80 publications

References 24 publications

Subarachnoid Hemorrhage Causing Cardiopulmonary Arrest: Resuscitation Profiles and Outcomes

Subarachnoid Hemorrhage Causing Cardiopulmonary Arrest: Resuscitation Profiles and Outcomes

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury

Contact Info

Product

Resources

About