title: Subarachnoid hemorrhage after resuscitation from out-of-hospital cardiac arrest.
abstract: BACKGROUND
  This study was undertaken to retrospectively investigate clinical features of subarachnoid hemorrhage (SAH) with cardiopulmonary arrest in patients achieving return of spontaneous circulation (ROSC) in order to explore the possibility of long-term survival.
  
  
  METHODS
  Of 143 SAH patients with cardiopulmonary arrest in our hospital between April 2004 and June 2012, data on 59 (41%) patients who attained ROSC were analyzed to determine the predictive factors for neurologic recovery and outcome. Recovery of brainstem reflexes and improvement of Glasgow Coma Scale (GCS) motor score were noted (postresuscitation neurologic restorative assessment, grade I) in 5, and 2 of these patients survived.
  
  
  RESULTS
  By-grade analysis of patient background characteristics revealed a significantly shorter duration of cardiac arrest (P = .001) and a significantly smaller adrenaline dose (P = .011) for grade I patients. A logistic analysis of 1-week survival data revealed significant differences in duration of cardiac arrest (P = .022) and adrenaline dose (P = .019), with odds ratios of 0.89 and 0.25, respectively. Cox regression analysis of mortality data revealed significant differences in the duration of cardiac arrest (P = .012), adrenaline dose (P < .0001), and location of ROSC (P = .016), with hazard ratios of 1.03, 1.43, and 1.98, respectively.
  
  
  CONCLUSIONS
  Cardiac arrest caused by SAH is a disease state with a grave prognosis, but there is the possibility of a good survival outcome when the administration of a small dose of adrenaline results in the rapid recovery of brainstem reflexes.
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan; Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Miyata
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan. Electronic address: tmikami@sapmed.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mikami
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Asai
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Iihoshi
authors.affiliation: Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Mikuni
authors.affiliation: Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
authors.forename: Eichi
authors.initials: E
authors.lastname: Narimatsu
mesh_terms: D000322:Adrenergic Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D001933:Brain Stem / Q000187:drug effects / Q000503:physiopathology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods; D004185:Disability Evaluation; D004452:Echocardiography; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012018:Reflex / Q000187:drug effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017741:Survivors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000322:Adrenergic Agonists; D004837:Epinephrine
keywords: Post–cardiac arrest syndrome; return of spontaneous circulation; witness