Factors Related to Subarachnoid Hemorrhage as a Cause of Out-of-Hospital Cardiac Arrest

ABSTRACT

PURPOSE: Subarachnoid hemorrhage (SAH) is a common cause of out-of-hospital cardiac arrest (OHCA). Early identification of patients with SAH induced OHCA may be helpful to emergency physicians when making therapeutic decisions. We conducted an investigation of the incidence and characteristics of patients with OHCA caused by non-traumatic SAH. METHODS: We conducted a retrospective review of cases of 236 OHCA survivors who had visited the emergency department (ED) of an urban tertiary care university hospital from January 2004 to December 2010. We excluded patients for whom there was an obvious cause or trauma. Clinical characteristics of SAH induced OHCA survivors were compared with those of SAH negative OHCA survivors. RESULTS: A total of 26 patients (19.11%) had been diagnosed with SAH. Compared with SAH negative survivors, SAH positive survivors were more likely to be female (odds ratio OR, 1.262; 95% confidence interval CI, 1.300-9.605), not to have Diabetes mellitus (OR, 0.180; 95% CI, 0.037-0.879), and to have a short duration of CPR time (OR, 1.074; 95% CI, 1.003-1.150). Results of the Cardiac Troponin T assay were less likely to be positive in patients with SAH induced OHCA, compared to those with SAH negative OHCA (OR, 0.071; 95% CI, 0.008-0.526). CONCLUSION: SAH is a more frequent cause of OHCA than originally believed. Immediate brain CT scan is useful in diagnosis of SAH when patient characteristics include female, non diabetes mellitus, short duration of CPR time, or negative TnT.