Key result
In patients with Hunt and Hess grade 5 subarachnoid hemorrhage, experiencing cardiac arrest requiring CPR resulted in 85% mortality compared to 68% without cardiac arrest (p=0.158).
Why the study?
Studies regarding the clinical outcome of poor-grade aneurysmal SAH (specifically H&H grade 5) and the influence of comorbidities, particularly cardiac arrest requiring CPR, are scant.
Does cardiac arrest requiring CPR worsen clinical outcomes in patients with poor-grade aneurysmal subarachnoid hemorrhage?
Cohort (n=80)
No
Does cardiac arrest requiring CPR worsen clinical outcomes in patients with poor-grade aneurysmal subarachnoid hemorrhage?
Absolute Event Rate: 85% vs 68%
p-value: p=0.158
Patients with poor-grade SAH who experience cardiac arrest have high mortality, but some survive, indicating they should not be universally excluded from appropriate neurosurgical treatment.
Cardiac arrest with CPR was not associated with significantly higher mortality in grade 5 SAH; leaves open prognostic impact and requires larger studies.
Background Poor-grade aneurysmal subarachnoid hemorrhage (SAH), in particular Hunt and Hess (H&H) grade 5 SAH, still has a high case-fatality rate. Recent studies regarding the clinical outcome of such patients and the influence of comorbidities, especially cardiac arrest (CA) requiring additional cardiopulmonary resuscitation (CPR), on the outcome of these patients are scant. Our primary objective was to assess the outcome of SAH H&H grade 5 patients and the influence of additional CA and requirement for CPR. Methods All patients with spontaneous aneurysmal SAH H&H grade 5 admitted to our hospital from 2001 to 2010 were enrolled in the study. Data were extracted from the hospital's clinical records and electronic database. The patients' clinical outcome at time of discharge was represented by the Glasgow Outcome Score and modified Rankin Scale (mRS). The influence of CA and additional CPR on patient outcome was analyzed. Results Of 80 SAH H&H grade 5 patients (median age 55 years), 21 patients (median age 50 years) experienced CA and received additional CPR. Mortality in SAH H&H grade 5 patients was 85% with CA and 68% without CA (p = 0.158). Overall, 22 of 59 patients with no CA survived, 4 with a good clinical outcome (mRS 0–3). Of the 21 with CA, only 3 survived, none with a good outcome (mRS 4–5). Due to the small subgroup surviving additional CA, a statistical difference could not be found between the groups. Aneurysm occlusion (p < 0.001) and aneurysm of the posterior circulation (p = 0.010) resulted in a more favorable clinical outcome. Conclusions Patients with SAH H&H grade 5 do survive and in 5% of cases even with a good outcome. Surviving an additional CA resulted in a less favorable outcome without statistical significance. Thus SAH H&H grade 5 patients with or without CA and additional CPR should not be excluded from appropriate neurosurgical treatment.
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Ridwan et al. (2019) conducted a cohort in Poor-grade aneurysmal subarachnoid hemorrhage (Hunt and Hess grade 5) (n=80). Cardiac arrest requiring cardiopulmonary resuscitation vs. No cardiac arrest was evaluated on Mortality at discharge (p=0.158). In patients with Hunt and Hess grade 5 subarachnoid hemorrhage, experiencing cardiac arrest requiring CPR resulted in 85% mortality compared to 68% without cardiac arrest (p=0.158).
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