Survival of cardiac arrest after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Survival of cardiac arrest (CA) after aneurysmal subarachnoid hemorrhage (SAH) is poorly characterized. We analyzed the clinical course and outcome of patients who survived resuscitation for CA after aneurysmal SAH.


METHODS
Medical records of all patients with acute SAH treated at Mayo Clinic between 1990 and 1997 were reviewed. Three hundred five consecutive patients with angiographically proven aneurysmal SAH presenting within 7 days of ictus were analyzed. CA was defined as a pulseless state, documented by medical personnel, for which resuscitation was performed. Outcome was measured with the Glasgow Outcome Scale score at longest follow-up (mean, 16 mo).


RESULTS
Data from 11 patients (3.6%) who had 14 episodes of CA were analyzed. Six patients had CA before reaching the hospital and were successfully resuscitated. Nine of 14 CA episodes occurred at hemorrhage or rehemorrhage. No patient with in-hospital CA failed to be resuscitated. Overall mortality in patients who had CA (46%) was higher than that of patients without CA (15%; P = 0.019). Outcome for all patients who had CA (mean Glasgow Outcome Scale score, 2.5) was worse than for patients without CA (mean Glasgow Outcome Scale score, 3.9; P = 0.005). However, half of the survivors of CA after SAH were living independently with limited deficit at longest follow-up.


CONCLUSIONS
Most cases of CA occur at the time of initial or recurrent SAH. Resuscitation for in-hospital CA is likely to be successful. Although CA after aneurysmal SAH is associated with significantly higher mortality, the outcome of survivors of CA is not worse than that for other patients after aneurysmal SAH.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. Toussaint.Gerard@mayo.edu
L Gerard
LG
Toussaint
Jonathan A
JA
Friedman
Eelco F M
EF
Wijdicks
David G
DG
Piepgras
Mark A
MA
Pichelmann
Jon I
JI
McIver
Robyn L
RL
McClelland
Douglas A
DA
Nichols
Fredric B
FB
Meyer
John L D
JL
Atkinson
D000328:Adult; D000800:Angioplasty, Balloon; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000628:therapy; D013534:Survival; D016896:Treatment Outcome