UMEM Educational Pearls

Title: Neurologic causes of cardiac arrest

Category: Neurology

Keywords: cardiac arrest, subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, seizure (PubMed Search)

Posted: 2/25/2015 by WanTsu Wendy Chang, MD
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Neurologic causes of cardiac arrest have not been well described.  Two recent retrospective studies looked at the epidemiology and clinical features of these patients.

Hubner P. et al.

  • Over 20 years, 154 patients suffered cardiac arrest from neurologic causes.
  • Diagnoses were made by CT in 123 patients (80%), autopsy in 28 patients (18%), and by history and clinical presentation in 4 patients (3%).
  • PEA was the presenting rhythm in 77 patients (50%).  Whereas 61 patients (40%) presented in asystole.
  • Neurologic causes included subarachnoid hemorrhage in 74 patients (48%), intracerebral hemorrhage in 33 patients (21%), seizures in 23 patients (15%), and ischemic stroke in 11 patients (7%).

Arnaout M. et al.

  • Over 13 years, 86 patients suffered out-of-hospital cardiac arrest from neurologic causes (2.3%).
  • PEA was the presenting rhythm in 16 patients (19%).  Whereas 66 patients (77%) presented in asystole.
  • After ROSC, 64% of cases had ECGs with possible ischemic abnormalities.
  • Neurologic causes included subarachnoid hemorrhage in 73 patients (85%), intracerebral hemorrage in 5 patients (6%), ischemic strokes in 5 patients (6%).

Neurologic causes of cardiac arrest are uncommon presentations that may be difficult to distinguish from cardiac etiology of cardiac arrest.  If history and clinical presentation suggests a neurologic cause, obtain a non-contrast head CT for evaluation.

References

Hubner P, Meron G, Kurkciyan I, et al. Neurologic causes of cardiac arrest and outcomes. J Emerg Med. 2014;47(6):660-667.

 

Arnaout M, Mongardon N, Deye N, et al. Out-of-Hospital Cardiac Arrest from Brain Cause: Epidemiology, Clinical features, and Outcome in a Multicenter Cohort. Crit Care Med. 2015;43(2):453-460.

 

 

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