UMEM Educational Pearls

Category: Neurology

Title: Neurologic causes of cardiac arrest

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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