Artikel
Prehospital sudden cardiac arrest following cardiopulmonary resuscitation in patient with aneurysmal subarachnoid haemorrhage – a retrospective multi-centric study
Kardiopulmonale Reanimation nach präklinischem Herzstillstand bei Patienten mit aneurysmatischer Subarachnoidalblutung – eine retrospektive multizentrische Studie
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Aneurysmal subarachnoid hemorrhage (SAH) is an acute neurologic condition that can be associated with out-of-hospital cardiac arrest (OHCA) in some cases. Thus, in addition to SAH, OHCA is the second acute problem that critically affects the outcome of these patients. Regardless of the genesis of OHCA, an immediate start of cardiopulmonary resuscitation (CPR) is important to ensure survival. However, little data is available for SAH patients. In this study we set out to investigate both the impact of lay CPR as well as the initial clinical management on the overall outcome of SAH patients presenting with prehospital OHCA.
Methods: A multi-center retrospective analysis of the local SAH databases for documented OHCA and CPR in the period from 2011 to 2020 was performed. Patients fulfilling these criteria were further analyzed for individual and disease specific parameters. Information on clinical management after hospital admission were gathered from the institutional health record systems, CPR linked data were extracted from the ambulance and emergency room reports. Data were correlated with patient´s survival as defined outcome parameter.
Results: 1120 patients with SAH were screened and 38 patients with SAH, OHCA and CPR (3.4%) were identified. Lay CPR was performed in 20 patients, further 18 (47.4%) patients CPR was carried out by emergency service. Time to CPR was significantly shorter for lay CPR (p<0.001). 17 patients (44.7%) were initially not assigned to a computer tomography (CT), time to CT from admission in this subgroup was significantly prolonged (154 ± 58 vs. 40 ± 23 min; p<0.033). Overall survival rate of patients with OHCA was 29.7% (11 patients). However, lay CPR (p=0.632) and shorter duration to the initial CT scan (p=0.065) were not associated with higher survival rates.
Conclusion: Sudden OHCA occurs frequently in patients with aneurysmal SAH. A prompt and high-quality CPR is crucial to facilitate patient’s survival, independent if performed as lay- or professional CPR. Although duration to initial CT scan after hospital admission did not influence the overall outcome, SAH should be considered as a reason for OHCA in every patient and cranial CT should be integrated into the diagnostic work-up of these patients.