Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiacarrest

Objective: Spontaneous subarachnoid haemorrhage as a cause of out-of-hospit al cardiac arrest is poorly evaluated. We analyse disease-specific and emer gency care data in order to improve the recognition of subarachnoid haemorr hage as a cause of cardiac arrest. Design: We searched a registry of cardia c arrest patients admitted after primarily successful resuscitation to an e mergency department retrospectively and analysed the records of subarachnoi d haemorrhage patients for predictive features. Results: Over 8.5 years, sp ontaneous subarachnoidal haemorrhage was identified as the immediate cause in 27 (4%) of 765 out-of-hospital cardiac arrests. Of these 27 patients, 24 (89%) presented with at least three or more of the following common featur es: female gender (63%), age under 40 years (44%), lack of co-morbidity (70 %), headache prior to cardiac arrest (39%), asystole or pulseless electric activity as the initial cardiac rhythm (93%), and no recovery of brain stem reflexes (89%). In six patients (22%), an intraventricular drain was place d, one of them (4%) survived to hospital discharge with a favourable outcom e. Conclusions: Subarachnoid haemorrhage complicated by cardiac arrest is a lmost always fatal even when a spontaneous circulation can be restored init ially. This is due to the severity of brain damage. Subarachnoid haemorrhag e may present in young patients without any previous medical history with c ardiac arrest masking the diagnosis initially. (C) 2001 Elsevier Science Ir eland Ltd. All rights reserved.