Abstract
Aneurysmal subarachnoid hemorrhage is one the most common causes of sudden death. We herein report a patient who presented with prehospital cardiopulmonary arrest (CPA) caused by subarachnoid hemorrhage who survived with a good neurological function. A 52-year-old male had a traffic accident, thereafter CPA occurred and cardiopulmonary resuscitation was then immediately performed by a bystander. An ambulance was requested, and advanced cardiopulmonary life support was administered upon arrival and thereafter was continued until reaching the hospital. The return of spontaneous circulation was observed about 23 minutes after the onset of the CPA. On arrival, the patient's consciousness level was E1VTM5. ECG showed an elevation of the ST segments at V1 to V5. A brain CT scan revealed a diffuse subarachnoid hemorrhage predominantly in the right hemisphere. Cerebral angiography showed a saccular aneurysm of the right middle cerebral artery. Because ocular deviation disappeared, a prompt light reflex was observed, the patient underwent a craniotomy to perform neck clipping of the aneurysm. The patient was discharged on foot without any neurological deficits. Therefore, immediate CPR by a bystander and intensive care have the potential to improve the survival rate and the functional outcome of subarachnoid hemorrhage patients presenting with prehospital CPA.
