Lay-Cardiopulmonary resuscitation after out-of-hospital cardiac arrest in aneurysmal subarachnoid hemorrhage patients - a retrospective multi-centric study

Abstract Introduction Aneurysmal subarachnoid hemorrhage (SAH) may be associated with sudden cardiac arrest (CA). Since there are many data on the positive impact of lay resuscitation on patient survival, but data are rare for SAH patients, our study aimed to investigate this aspect. Methods In this multi-center retrospective analysis, we reviewed the local SAH databases for OHCA and CPR from 01/2011 to 12/2020. Data on CPR were extracted from the ambulance and emergency room (ER) reports. Information on clinical management after hospital admission were gathered from the institutional health records. Collected data were correlated with patient survival as defined outcome parameter. Results We screened 1120 patients with SAH and identified 38 patients with SAH, OHCA and CPR (3.4%). Our cohort showed a high proportion of posterior circulation aneurysms (n = 17, 44.7%). Lay CPR was performed in 20 patients. Time to CPR was significantly shorter for lay CPR (p < 0.001). 17 patients (44.7%) were not initially assigned to CCT, resulting in a significantly prolonged time interval (154 ± 58 vs. 40 ± 23 min; p < 0.033). Overall survival rate of patients with OHCA and CPR was 29.7% (11 patients). However, pre-hospital lay CPR (p = 0.632) and shorter duration to the initial CCT after admission (p = 0.065) did not influence the outcome. Conclusions Sudden OHCA occurs regularly in patients with SAH. A timely initiated and high-quality CPR is crucial to facilitate patient’s initial survival. Although prolonged time to CCT does not affect survival, SAH should be considered as a cause of CA and CCT should be integrated into the diagnostic algorithm.