Abstract P547: Cardiac Arrest in Patients Who Present With Subarachnoid Hemorrhage is Associated With Worse Outcomes

Abstract

Introduction: Subarachnoid hemorrhage (SAH) can be a devastating neurologic condition that leads to cardiac arrest (CA), and ultimately poor clinical outcomes. Existing literature on this subject reveal a dismal prognosis when analyzing relatively small sample sizes. We aimed to further elucidate the incidence, mortality rates, and outcomes of CA patients with SAH using large-scale population data. Methods: A retrospective cohort study was conducted using the National Inpatient Sample (NIS) database. Patients included in the study met criteria using International Classification of Diseases (ICD) codes 9th and 10th edition of: non-traumatic SAH, CA cause unspecified, and CA due to other underlying conditions between 2008 and 2014. For all regression analyses, a p-value of <0.05 was considered statistically significant. Results: We identified 170,869 patients hospitalized for non-traumatic SAH. Within these, there was a 3.17% incidence of CA. The mortality rate in CA with SAH was 82% (vs non-CA 18.4%, p< 0.001). Of the survivors of CA with SAH, 15.7% were discharged to special facilities and services (vs non-CA 37.6%, p<0.0001). The remaining 2.3% were discharged home (vs non-CA 44.0%, p<.0001). Higher NIS SAH severity score (NIS-SSS) was a predictor of CA in SAH patients (p <.0001). Patients treated with aneurysm clipping and coiling had lower odds ratio of CA (p <.0001). Conclusion: The study confirms the poor prognosis of patients with CA and SAH using large-scale population data. Patients that underwent aneurysm treatment show lower association with CA. Findings presented here provide useful data for clinical decision making and guiding goals of care discussion with family members. Further studies may identify interventions and protocols for treatment of these severely ill patients.