Out-of-hospital cardiac arrest following aneurysmal subarachnoid hemorrhage (OHCA-SAH)

Position du problème et objectif(s) de l’étude

Introduction:
Around 10% of non-traumatic cardiac arrests are attributed to subarachnoid hemorrhage (SAH). Similarly, it is estimated that around 10% of patients admitted with SAH experience cardiac arrest during the prehospital phase. Currently, there is limited data regarding the prognosis of patients who suffer a cardiac arrest due to SAH. However, most series suggest that the prognosis of out-of-hospital cardiac arrests (OHCA) complicating SAH is extremely poor due to accumulation of devastating neurological conditions.(1–3)
The objective of our study was to determine the 3-month prognosis of patients who experienced successfully resuscitated OHCA, due to aneurysmal SAH-aSAH).

Matériel et méthodes

Methods:
This is preliminary data from 3 centers (Reims, Nice, Créteil) participating in an ongoing multicenter retrospective study (15 centers) conducted between 2014 and 2024 in university-affiliated neuroICUs. The study received approval from the CERAR ethics committee (IRB 00010254- 2024–116).
All adult patients experiencing aSAH complicated with OHCA were included. The primary objective was to determine the 3-month neurological prognosis using the modified Rankin Scale (mRS) in cases of aSAH identified following OHCA.

Résultats & Discussion

Results:
In the 3 centers involved in this preliminary study, 5133 cases of aSAH were admitted during this 10-yrs period, including 70 (1.36%) who experienced successfully resuscitated OHCA. The median age was 54 [41-61] years, with a sex ratio M/F of 0.9. The initial cardiac rhythm was shockable (VF / pulseless VT) in only 10% of cases. No-flow and low-flow durations were 3.5±4.6 minutes and 19±13 minutes, respectively. Only 4 patients survived at 3 months. Age, location of OHCA not significantly different between survivors and non-survivors (Table 1). It is noteworthy that 66% of non-survivors and 100% of survivors received bystander cardiopulmonary resuscitation ), although the difference was not statistically significant (p = 0.1). Both the no-flow (1 [0–5] min vs. 0 [0–0] min, p = 0.06) and the low-flow durations (18 [10–25] min vs. 6 [3–9] min, p = 0.01) were shorter among survivors.
Post-resuscitation pupillary examination showed that none of the survivors had bilateral mydriasis, while the majority of deceased patients did (0 (0%) vs. 45 (68.2%), p = 0.01).
Most of patients had no specific aneurysm securing, but the latter was performed in all survivors, mainly through interventional neuroradiology. ICU length of stay was extremely short in non-survivors whereas survivors experienced very long hospitalization At 3 months (Fig. 2), only 1 survivor (had a favorable neurological outcome (mRS ≥ 2).
Among the causes of death (Fig. 2), 66.6% (n = 44) were due to brain death, 16.7% to multi-organ failure, and 10.6% to care withdrawal/withholding .

Conclusion

Conclusion:
These preliminary results from the OHCA-SAH study demonstrate that the 3-month functional prognosis following OHCA secondary to aSAH is extremely poor. If confirmed in the full study cohort, and despite the risk of self-fulfilling prophecy, this grim prognosis open the door to the possibility of organs harvesting

Auteurs

Florine DARTY (1) , Vincent LEGROS (1), Jessica CATEURA (2), Nicolas MONGARDON (3) - (1)Service D’anesthésie-Réanimation Et Médecine Périopératoire,, Reims, France, (2)Service D’anesthésie-Réanimation Et Médecine Périopératoire,, Nice, France, (3)Service D’anesthésie-Réanimation Et Médecine Périopératoire,, Creteil, France

Orateur(s)

Florine DARTY (Reims)