Prevalence of Intracranial Hemorrhage in Outside Hospital Cardiac Arrest Patients

Abstract

SESSION TITLE: ICU Management SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: The purpose of this study is to evaluate patients with out-of-hospital cardiac arrest (OHCA) who have intracranial hemorrhage (ICH), and to determine if a protocol could be established in the emergency department (ED) to have head computed tomography (CT) performed prior to cardiac catheterization in certain patient populations. This is a retrospective study with the following specific aims: Aim 1) Determine the proportion of patients suffering an OHCA with return of spontaneous circulation (ROSC) diagnosed as having ICH. Aim 2) Compare demographic characteristics and co-morbidities of patients with and without ICH to determine which patient population is prone to OHCA and ICH, excluding those related to trauma. METHODS: This is a retrospective, multi-center (three institutions: Level I and II) study where 1987 patients over the age of 18 who had an OHCA were screened for obtaining ROSC either in the field or in the ED between January 1, 2010 and December 31, 2015. Out of 1987, 293 patients obtained ROSC. Information regarding pre-existing co-morbities; history of cerebrovascular diease, hypertension, diabetes mellitus, chronic kidney disease, tobacco use, anticoagulation therapy was collected. Presenting cardiac rhythm and whether head CT was obtained and presence of ICH on head CT was recorded. RESULTS: Of the 293 patients who experienced OHCA with ROSC, 50 (17.1%) patients had a head CT, 237 (80.9%) did not have a head CT, and presence/absence of a head CT was not documented for 6 (2.0%) patients. Patients who had a head CT were younger (mean: 59.3 years; SD: 18.5) than patients who did not have a head CT (mean: 65.9; SD: 18.0) (t: 2.34; df: 285; p=0.020). A smaller proportion of patients with hypertension, CKD had a head CT (14.7%, 6.0%) than patients without hypertension, CKD (27.9%, 22.7%) (χ2(1): 5.52; p=0.019), (χ2(1): 7.02; p=0.008). There was no difference in obtaining or not obtaining a head CT based on sex (χ2(1): 0.60; p=0.455), smoking status (χ2(1): 1.40; p=0.238), diabetes (χ2(1): 3.40; p=0.065), cerebrovascular disease (p=0.199), or anticoagulation therapy (p=0.158). Comparing presenting rhythm who had a CT; ventricular fibrillation/tachycardia (29.5%) , pulseless electrical activity/asystole (13.4%) (χ2(1): 7.78; p=0.005). Among the 50 patients who experienced OHCA with ROSC and had a head CT, 12 (24.0%) were diagnosed with ICH. Among patients who had a head CT, a greater proportion of patients with pulseless electrical activity/asystole had a diagnosis of ICH (42.9%) than patients with ventricular fibrillation/tachycardia (5.6%) (p=0.018). CONCLUSIONS: One fourth of the population presenting with OHCA who obtained ROSC were diagnosed with intracranial hemorrhage and presenting rhythm was PEA/asystole about 43% of the time. CLINICAL IMPLICATIONS: A substantial number of patients presenting with PEA/asytole who obtained ROSC had a diagnosis of ICH.Prompt neurosurgical intervention and transfer to appropriate facility may improve survival rate and functional outcome. Further pilot protocol can be established which triggers clinicians to obtain a head CT in patients with PEA/asystole who obtain return of spontaneous circulation. DISCLOSURE: The following authors have nothing to disclose: Aileen Ruffino, Sarita Gautam, Kruti Patel, Christy Collins, Moumita Chatterjee, Matthew Majzun No Product/Research Disclosure Information