ArticleActa neurochirurgica2026
Early aggressive treatment in WFNS grade v aneurysmal subarachnoid hemorrhage with respiratory or cardiac arrest.
Article in Acta neurochirurgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWith advances in emergency medical systems, an increasing number of patients with aneurysmal subarachnoid hemorrhage (SAH) complicated by respiratory or cardiac arrest (CA) are transported alive to emergency centers. However, the pathophysiology and optimal management of these ultra-severe cases remain poorly defined. We hypothesized that cardiopulmonary status at presentation may help identify patients with physiological reversibility and potential for meaningful recovery. We evaluated clinical outcomes and factors associated with favorable recovery in patients with World Federation of Neurological Societies (WFNS) Grade V SAH, including those presenting with respiratory or CA.
methodsWe retrospectively analyzed 87 consecutive patients with WFNS Grade V aneurysmal SAH admitted between 2008 and 2017. Patients were stratified according to cardiopulmonary status at presentation into three subgroups: Grade V-1 (no arrest), Grade V-2 (respiratory arrest without CA), and Grade V-3 (CA). Neurological outcomes at 3 months were assessed using the Glasgow Outcome Scale (GOS). Predictors of favorable outcome in the Grade V-3 subgroup were examined using multivariable logistic regression analysis.
resultsOverall, 13 patients (14.9%) achieved favorable outcomes (GOS moderate disability or good recovery). Favorable outcomes occurred in 60.0% of Grade V-1 patients, 14.3% of Grade V-2 patients, and 7.9% of Grade V-3 patients. In the Grade V-3 subgroup, five patients achieved social independence following rapid resuscitation and definitive aneurysm treatment. Ventricular fibrillation at emergency medical service contact and shorter cardiopulmonary resuscitation duration were significantly associated with favorable outcomes, whereas lactate showed a non-significant association.
conclusionsMeaningful neurological recovery may occur even in CA-associated WFNS Grade V SAH in selected patients. Cardiopulmonary status at presentation and markers of physiological reversibility, including ventricular fibrillation and shorter CPR duration, were associated with favorable outcomes. Favorable outcomes occurred exclusively in patients who underwent definitive aneurysm treatment, suggesting that aggressive management may be beneficial in carefully selected patients with physiological reversibility.
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