"Pseudo-subarachnoid hemorrhage sign" on early brain computed tomography in out-of-hospital cardiac arrest survivors receiving targeted temperature management.
Newly updated guidelines suggest brain computed tomography for out-of-hospital cardiac arrest survivors to identify a neurologic cardiac arrest cause. We hypothesized that the "pseudo-subarachnoid hemorrhage" (p-SAH) sign in cardiac arrest survivors is associated with poor outcome.



We retrospectively evaluated the registries of 2 tertiary hospitals, identifying 836 adult (≥18 years) patients achieving return of spontaneous circulation after out-of-hospital cardiac arrest. Among them, 398 patients with brain computed tomography within 6 hours after return of spontaneous circulation and received targeted temperature management from 2009 to 2014 were included. Clinical characteristics and outcomes of patients with and without p-SAH were compared.



The prevalence of p-SAH sign was 8.0%. The p-SAH group more frequently had asystole as first rhythm and nonwitnessed arrest, predominantly resulting from asphyxia (56.3%). Targeted temperature management characteristics were not different between groups, although the p-SAH cohort had worse neurologic outcomes at discharge (100% vs 67.2%; P < .001). Pseudo-subarachnoid hemorrhage had 11.5% sensitivity, 100% specificity, 100% positive predictive value, and 32.8% negative predictive value for poor neurologic outcome.



Pseudo-subarachnoid hemorrhage sign might be one of the simple methods to identify poor neurologic outcome early. However, further prospective studies will be needed to clarify the clinical implication of the p-SAH sign.
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Byung Kook
BK
Lee
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Youn-Jung
YJ
Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Seung Mok
SM
Ryoo
Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
Su Jin
SJ
Kim
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Dong Hun
DH
Lee
Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Kyung Woon
KW
Jeung
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: wonpia73@naver.com.
Won Young
WY
Kim
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest; D011446:Prospective Studies; D056910:Republic of Korea; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods
Brain computed tomography; Out-of-hospital cardiac arrest; Prognosis; Pseudo-subarachnoid hemorrhage; Targeted temperature management