重症くも膜下出血患者の治療戦略とその転帰

抄録

Patients with poor-grade subarachnoid hemorrhage have a very poor prognosis, especially those with cardiopulmonary arrest and/or bilateral dilated pupils. Therapeutic indications for patients with poor-grade subarachnoid hemorrhage vary depending on the institution; however, we perform clipping or coil embolization in these patients with very poor-grade subarachnoid hemorrhage if their vital signs are stable at the time of admission. In this study, we summarize the outcomes of 31 patients with poor-grade subarachnoid hemorrhage seen between January 2015 and April 2017. Among the 31 patients, 13 patients had cardiopulmonary arrest at the time of admission and/or prehospital, and 15 patients had bilateral dilated pupils. Among these 13 patients with cardiopulmonary arrest, seven patients underwent clipping or coil embolization because their vital signs could be stabilized. The functional outcomes of these seven patients were very poor: mRS 1 (1 patient), mRS 4 (1 patient), and mRS 5 (5 patients); however, all of these patients survived 30 days after the subarachnoid hemorrhage onset. Meanwhile, the other nine patients with unstable vital signs and who could therefore not undergo clipping or coil embolization died within 30 days after the subarachnoid hemorrhage onset.

In conclusion, although the functional outcomes of patients with poor grade subarachnoid hemorrhage and cardiopulmonary arrest were very poor, a minority of these patients had good functional outcomes.