1160: COLLAPSE-RELATED TRAUMATIC INTRACRANIAL HEMORRHAGE AFTER OUT-OF-HOSPITAL CARDIAC ARREST

Abstract

Introduction: Sudden collapse of out-of-hospital cardiac arrest (OHCA) patients due to internal cardiac arrest can be complicated by subsequent traumatic head injuries. Collapse-related traumatic intracranial hemorrhage (CRTIH) is especially important due to likely subsequent antiplatelet and anticoagulation therapy and the potential risk of exacerbation of hemorrhage and mortality. However, the prevalence and risk of CRTIH have not yet been elucidated. We hypothesized that CRTIH after OHCA is rarely observed but associated with unfavorable outcomes. Methods: We conducted a multicenter, retrospective observational study over a 13-year period (2007-2019) at five emergency and critical care centers. Inclusion criteria: adult OHCA patients with non-traumatic causes of arrest who were resuscitated and underwent head computed tomography. Exclusion criteria: stroke (ischemic/hemorrhagic) as cause of OHCA. The study’s primary outcome was to elucidate the prevalence of CRTIH. Baseline characteristics were compared between the CRTIH group and non-CRTIH group. Further, factors related to unfavorable patient neurological outcomes were examined using multivariable logistic regression analysis. Finally, the detailed clinical courses of CRTIH were described. Results: CRTIH following OHCA was observed in 8/427 (1.9%) patients. CRTIH was associated with collapse outside the home (CRTIH; 7/8 [87.5%] vs. non-CRTIH; 270 /419 [12.5%], p=0.027), external head surface injury (CRTIH; 4/8 [50.0%] vs. non-CRTIH; 18/419 [4.3%], p=0.008), and extracorporeal membrane oxygenation (CRIH; 3/8 [37.5%] vs. non-CRTIH; 44/419 [10.5%], p=0.047). CRTIH was not significantly associated with unfavorable outcome at 28 days (adjusted odds ratio 0.68; 95% confidence interval 0.10–4.70; p =0.697). Among eight patients with CRTIH, six had collapsed from orthostatic position, five were administered anticoagulants or antiplatelets after admission, two had hemorrhage exacerbation, one underwent neurosurgical decompression. Conclusions: CRTIH was rare among our patients with OHCA and was not significantly associated with unfavorable outcomes. However, cautious monitoring for exacerbation of hemorrhage in CRTIH patients with anticoagulant/antiplatelet/ECMO use after OHCA is needed.