Inamasu Joji, Nakagawa Yu, Kuramae Takumi, Nakatsukasa Masashi, Miyatake Satoru
Department of Neurosurgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Neurol Med Chir (Tokyo). 2011;51(9):619-23. doi: 10.2176/nmc.51.619.
Aneurysmal subarachnoid hemorrhage (SAH) is a common cause of cardiopulmonary arrest (CPA). The outcomes of SAH patients presenting with CPA are extremely poor, and long-term survivors have occasionally been reported, but the circumstances under which SAH-CPA patients achieve long-term survival are unclear. Neurosurgeons will have to determine whether a SAH-CPA patient is brain-dead or not more often after enactment of the revised Organ Transplantation Act. Prediction of survival length may be important not only to neurosurgeons, but also to the transplantation team. A retrospective study was conducted to elucidate how often brainstem function was recovered in resuscitated SAH-CPA patients and whether the recovery was associated with longer survival. Among 315 patients with non-traumatic SAH admitted to our institution during 6 years, 35 (11%) presented with CPA. Ventricular fibrillation (VF) as initial cardiac rhythm was rare, observed only in 1 patient. The survival length ranged from 1 to 15 days (mean 3.5 ± 0.7 days), and none achieved long-term survival. Return of brainstem function, represented by spontaneous respiration and/or reactive pupils, was observed in 6 patients (17%), but was only partial and transient. Cardiac arrest to return of spontaneous circulation interval tended to be shorter in patients with transient recovery of the brainstem function than in those without recovery. However, the survival length was not significantly different between the two groups. In addition to the 35 SAH-CPA patients, another 44 SAH patients lost both brainstem reflexes and spontaneous respiration within 72 hours of admission. As a result, 79 (25%) of the 315 SAH patients were considered to have sustained fatal, irreversible brain damage. Review of previous experience suggests that SAH-CPA patients may survive only if the cause of cardiac arrest is VF and not brainstem damage/respiratory arrest. Approximately one-third of resuscitated SAH-CPA patients may die within 24 hours of arrival, for whom the declaration of brain death may be difficult.
动脉瘤性蛛网膜下腔出血（SAH）是心脏骤停（CPA）的常见原因。出现CPA的SAH患者预后极差，长期存活者偶有报道，但SAH-CPA患者实现长期存活的情况尚不清楚。修订后的《器官移植法》颁布后，神经外科医生将更频繁地确定SAH-CPA患者是否脑死亡。预测存活时长不仅对神经外科医生很重要，对移植团队也很重要。进行了一项回顾性研究，以阐明复苏后的SAH-CPA患者脑干功能恢复的频率，以及这种恢复是否与更长的存活时间相关。在6年期间入住我院的315例非创伤性SAH患者中，35例（11%）出现CPA。室颤（VF）作为初始心律很少见，仅在1例患者中观察到。存活时长为1至15天（平均3.5±0.7天），无一例实现长期存活。6例患者（17%）观察到以自主呼吸和/或反应性瞳孔为代表的脑干功能恢复，但只是部分且短暂的。脑干功能短暂恢复的患者，心脏骤停至自主循环恢复的间隔时间往往比未恢复的患者短。然而，两组的存活时长无显著差异。除了35例SAH-CPA患者外，另有44例SAH患者在入院72小时内丧失了脑干反射和自主呼吸。结果，315例SAH患者中有79例（25%）被认为遭受了致命的、不可逆的脑损伤。回顾以往经验表明，SAH-CPA患者可能只有在心脏骤停的原因是VF而非脑干损伤/呼吸骤停时才能存活。约三分之一复苏后的SAH-CPA患者可能在到达后24小时内死亡，对于这些患者，脑死亡的判定可能很困难。
