NYMC Faculty Publications

Cardiac Arrest in Spontaneous Subarachnoid Hemorrhage and Associated Outcomes

Authors

Eric Feldstein, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Jose F. Dominguez, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Gurkamal Kaur, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Smit D. Patel, Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; and.
Alis J. Dicpinigaitis, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Rosa Semaan, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Leanne E. Fuentes, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Jonathan Ogulnick, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Christina Ng, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Cameron Rawanduzy, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Haris Kamal, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Jared Pisapia, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Simon Hanft, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Krishna Amuluru, Department of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
Srihari S. Naidu, Department of Medicine, Westchester Medical Center, New York Medical College of Medicine.
Howard A. Cooper, Department of Cardiology, Westchester Medical Center, New York Medical College of Medicine.
Kartik Prabhakaran, Department of Surgery, Westchester Medical Center, New York Medical College of Medicine, Valhalla, New York.
Stephan A. Mayer, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine.

Author Type(s)

Faculty, Resident/Fellow

Journal Title

Neurosurgical Focus

First Page

E6

Document Type

Article

Publication Date

3-1-2022

Department

Neurosurgery

Second Department

Medicine

Third Department

Surgery

Abstract

OBJECTIVE: The authors sought to analyze a large, publicly available, nationwide hospital database to further elucidate the impact of cardiopulmonary arrest (CA) in association with subarachnoid hemorrhage (SAH) on short-term outcomes of mortality and discharge disposition. METHODS: This retrospective cohort study was conducted by analyzing de-identified data from the National (Nationwide) Inpatient Sample (NIS). The publicly available NIS database represents a 20% stratified sample of all discharges and is powered to estimate 95% of all inpatient care delivered across hospitals in the US. A total of 170,869 patients were identified as having been hospitalized due to nontraumatic SAH from 2008 to 2014. RESULTS: A total of 5415 patients (3.2%) were hospitalized with an admission diagnosis of CA in association with SAH. Independent risk factors for CA included a higher Charlson Comorbidity Index score, hospitalization in a small or nonteaching hospital, and a Medicaid or self-pay payor status. Compared with patients with SAH and not CA, patients with CA-SAH had a higher mean NIS Subarachnoid Severity Score (SSS) ± SD (1.67 ± 0.03 vs 1.13 ± 0.01, p < 0.0001) and a vastly higher mortality rate (82.1% vs 18.4%, p < 0.0001). In a multivariable model, age, NIS-SSS, and CA all remained significant independent predictors of mortality. Approximately 18% of patients with CA-SAH survived and were discharged to a rehabilitation facility or home with health services, outcomes that were most predicted by chronic disease processes and large teaching hospital status. CONCLUSIONS: In the largest study of its kind, CA at onset was found to complicate roughly 3% of spontaneous SAH cases and was associated with extremely high mortality. Despite this, survival can still be expected in approximately 18% of patients.

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