Can a brain hemorrhage cause cardiac arrest?

Brain Hemorrhage as a Cause of Cardiac Arrest

Brain hemorrhage can cause cardiac arrest, particularly in cases of subarachnoid hemorrhage (SAH), which is the leading neurologic cause of cardiac arrest. 1

Mechanisms and Pathophysiology

• Intracranial hemorrhage can lead to sudden increases in intracranial pressure (ICP), which may trigger autonomic nervous system dysfunction and subsequent life-threatening cardiac arrhythmias 2
• The sudden eruption of an intracranial hemorrhage destroys and displaces brain tissue, inducing increased ICP that can affect cardiopulmonary function 3
• Hemorrhages involving the right hemisphere, particularly those affecting the insula, carry a higher risk of cardiac complications due to disturbances in autonomic nervous system function 3
• The post-cardiac arrest syndrome following brain hemorrhage includes myocardial dysfunction, systemic ischemia/reperfusion response, and persistent neurological injury 3

Types of Brain Hemorrhage Associated with Cardiac Arrest

• Subarachnoid hemorrhage (SAH) is the most common neurologic cause of cardiac arrest, accounting for approximately 48% of neurologic-origin cardiac arrests 1
• Intracerebral hemorrhage (ICH) accounts for approximately 21% of neurologic-origin cardiac arrests 1
• Other neurologic causes include epileptic seizures (15%), ischemic stroke (7%), and other neurologic diseases (8%) 1

Clinical Presentation and Recognition

• Patients with brain hemorrhage-induced cardiac arrest often present with pulseless electrical activity (50%) or asystole (40%) as the initial rhythm, rather than ventricular fibrillation (10%) 1
• A history of sudden severe headache preceding collapse is a critical diagnostic clue that may indicate intracranial hemorrhage as the cause of cardiac arrest 4
• However, approximately half of patients whose cardiac arrest is due to intracranial hemorrhage may collapse without complaining of headache 4
• ECG changes secondary to stroke may include ST-segment depression, QT dispersion, inverted T waves, and prominent U waves 3

Outcomes and Prognosis

• While return of spontaneous circulation (ROSC) is achieved in up to 90% of patients with neurologic-origin cardiac arrest, only about 14% survive at 6-month follow-up 1
• Only 9% of patients with neurologic-origin cardiac arrest achieve favorable neurological outcomes 1
• The prognosis for cardiac arrest due to intracranial hemorrhage is invariably poor, even though patients may be temporarily resuscitated 4

Management Considerations

• Monitoring of neurological and cardiopulmonary function is essential in patients with brain hemorrhage 3
• Management should focus on:
  • Optimizing respiratory effort and oxygenation 3
  • Controlling systemic hypertension 3
  • Preventing and treating seizures 3
  • Managing increased intracranial pressure 3
• For patients with suspected intracranial hemorrhage, rapid neuroimaging with CT or MRI is mandatory to distinguish hemorrhage type and guide treatment 5
• Aggressive blood pressure management is recommended to prevent hematoma growth 5
• ICP monitoring should be considered in patients with Glasgow Coma Scale (GCS) ≤8, those with hydrocephalus, or those with clinical evidence of transtentorial herniation 5

Prevention and Public Education

• Focus should be directed toward avoiding sudden death from potentially treatable cerebral lesions 4
• Public education to promote awareness of symptoms of potentially lethal hemorrhagic stroke is warranted 4
• Early recognition and treatment of warning signs such as sudden severe headache may prevent progression to cardiac arrest 4

Brain hemorrhage, particularly subarachnoid hemorrhage, represents an important but often overlooked cause of cardiac arrest with generally poor outcomes. Recognition of preceding symptoms such as sudden severe headache and non-shockable initial rhythms can help identify this etiology.