Subarachnoid Hemorrhage as a Cause of Out-of Hospital Cardiac Arrest: A Prospective Computed Tomography Study

Introduction: Head computed tomography (HCT) is often performed to assess for hypoxic-ischemic brain injury in resuscitated out of hospital cardiac arrest (OHCA) patients. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome post OHCA. Methods: We included subjects from a prospectively collected cardiac arrest database of OHCA adult patients who received targeted temperature management (TTM) at two academic suburban hospitals from 2009-Sept-2018. Cases were included if a HCT was performed in the emergency department (ED). Patient demographics and cardiac arrest variables were collected. HCT results were abstracted by study authors from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, stroke). Outcomes were survival to discharge or cerebral performance scores (CPC) at discharge of three or four (poor neurologic outcome). Descriptive statistics, univariate, multivariate, survival, and interrater reliability analysis were performed. Results: During the study period, there were 425 OHCA, 277 cases had ED HCTs performed; 254 cases were included in the final survival analysis. Patients were predominately male, 189 (65.0%), average age 60.9 years, average BMI of 30.5. Of all cases, 44 (15.9%) showed CE on CT. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (OR: 9.23; 95% CI 1.73, 49.2), and 9.1-fold greater odds of death (OR: 9.09: 95% CI 2.4 33.9). In adjusted analysis, CE was associated with 14.9-fold greater odds of poor CPC outcome (AOR: 14.9, 95% CI, 2.49, 88.4), and 13.7-fold greater odds of death (AOR: 13.7, 95% CI, 3.26, 57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (HR: 3.56: 95% CI 2.34, 5.41). Interrater reliability demonstrated excellent agreement between reviewers for CE on HCT (κ = 0.86). Conclusion: The results identify that abnormal HCTs early in the post-arrest period in OHCA patients are associated with poor rates of survival and neurologic outcome. Prospective work is needed to confirm whether selection bias or other variables confound this association.

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Interobserver Variability in the Recognition of Hypoxic–Ischemic Brain Injury on Computed Tomography Soon After Out-of-Hospital Cardiac Arrest

Neurocritical Care ◽

10.1007/s12028-019-00900-7 ◽

2020 ◽

Vol 33 (2) ◽

pp. 414-421

Author(s):

Andrew Caraganis ◽

Maximilian Mulder ◽

Robert R. Kempainen ◽

Roland Z. Brown ◽

Mark Oswood ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Brain Injury ◽

Interobserver Variability ◽

Ischemic Brain Injury ◽

Ischemic Brain ◽

Hypoxic Ischemic Brain Injury ◽

Hospital Cardiac Arrest

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Delayed diaphragmatic rupture presenting with acute gastric volvulus

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13946184902082 ◽

2014 ◽

Vol 96 (7) ◽

pp. e17-e19 ◽

Cited By ~ 2

Author(s):

JML Williamson ◽

R Macleod ◽

A Hollowood

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Epigastric Pain ◽

Rare Complication ◽

Gastric Volvulus ◽

Diaphragmatic Rupture ◽

Motorcycle Accident ◽

Thoracic Computed Tomography ◽

Acute Gastric Volvulus ◽

Hospital Cardiac Arrest

Gastric volvulus is a rare complication of diaphragmatic rupture. We report the case of an 82-year-old man who presented following an out-of-hospital cardiac arrest. Chest radiography and thoracic computed tomography revealed an acute gastric volvulus and a chronic diaphragmatic hernia containing transverse colon and abdominal viscera. He had complained of retching and associated epigastric pain prior to collapse, and had sustained a motorcycle accident approximately 60 years earlier. Insertion of a nasogastric tube was unsuccessful (completing Borchardt’s diagnostic triad) and his condition prevented both operative and endoscopic reduction of his volvulus. He died soon afterwards.

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Subarachnoid Hemorrhage after Resuscitation from Out-of-hospital Cardiac Arrest

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.03.024 ◽

2014 ◽

Vol 23 (3) ◽

pp. 446-452 ◽

Cited By ~ 2

Author(s):

Kei Miyata ◽

Takeshi Mikami ◽

Yasufumi Asai ◽

Satoshi Iihoshi ◽

Nobuhiro Mikuni ◽

...

Keyword(s):

Cardiac Arrest ◽

Subarachnoid Hemorrhage ◽

Hospital Cardiac Arrest

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Subarachnoid hemorrhage in survivors of out-of-hospital cardiac arrest: true or not?

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2005.08.003 ◽

2006 ◽

Vol 24 (1) ◽

pp. 123-125 ◽

Cited By ~ 3

Author(s):

Min-Shan Tsai ◽

Chih-Wei Yang ◽

Liang-Chung Huang ◽

Cheng-Chun Hsieh ◽

Wen-Jone Chen ◽

...

Keyword(s):

Cardiac Arrest ◽

Subarachnoid Hemorrhage ◽

Hospital Cardiac Arrest

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Early computed tomography in victims of non-traumatic out-of-hospital cardiac arrest

Internal and Emergency Medicine ◽

10.1007/s11739-015-1353-y ◽

2015 ◽

Vol 11 (2) ◽

pp. 237-243 ◽

Cited By ~ 6

Author(s):

Martin Christ ◽

Katharina Isabel von Auenmueller ◽

Jan Peter Noelke ◽

Benjamin Sasko ◽

Scharbanu Amirie ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Hospital Cardiac Arrest

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Abstract 375: Utility of Routine Early Head Computed Tomography Following Non-Traumatic Out-Of Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.375 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Bradley J Petek ◽

David E Hamilton ◽

Lindsay G Panah ◽

Philip E Dormish ◽

Sean R Mendez ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Clinical Utility ◽

Spontaneous Circulation ◽

Head Ct ◽

Shockable Rhythm ◽

Baseline Characteristics ◽

Poor Outcomes ◽

Head Computed Tomography ◽

Hospital Cardiac Arrest

Introduction: Head computed tomography (CT) is frequently performed in survivors of out-of-hospital cardiac arrest (OHCA). However, the clinical utility of routine, early head CT in these patients is not well understood. We sought to characterize the associations between findings on early head CT with presenting characteristics and outcomes in survivors of OHCA. Hypothesis: Presence of early intracranial swelling is associated with poor outcomes. Methods: This is a retrospective analysis from a multicenter cohort of 432 patients with non-traumatic OHCA between 2/1/17 through 4/1/19. Patients were included if they underwent head CT <24 hrs after return of spontaneous circulation. Head CT findings were based on reads performed by local radiologists. Intracranial swelling was defined as loss of gray-white matter differentiation, sulcal effacement, and/or cerebral edema. Underlying cause of OHCA was adjudicated by trained physicians. Baseline characteristics and outcomes were compared between those with and without intracranial swelling. Result: Early head CT (<24 hrs) was performed in 378 (87.5%) patients with OHCA. Intracranial swelling was present in 97 (25.7%) patients with early head CT, and 14 (3.7%) had evidence of intracranial hemorrhage (ICH, Table). Of the patients presenting with ICH, 3/14 (21.4%) had shockable rhythms, 7/14 (50%) had subarachnoid hemorrhage, and ICH was the adjudicated cause of arrest in 10/14 (71.4%) patients. Patients with intracranial swelling were younger, less likely to have presented with a shockable rhythm, cardiac etiology, and witnessed OHCA. They were more likely to have a suppressed EEG, anoxia on MRI, and were less likely to survive to hospital discharge. Conclusions: In survivors of non-traumatic OHCA, routine, early (<24 hrs) head CT identified ICH in 3.7% of patients, and ICH was the adjudicated cause of arrest in 2.6% of patients. Intracranial swelling was present in more than 1/4 of patients, and associated with poor outcomes.

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