Survival after subarachnoid hemorrhage using brain hypothermia after recovery of spontaneous circulation from cardiopulmonary arrest: A case report

A 55-year-old woman was admitted to our intensive care unit with cardiopulmonary arrest (CPA). On admission, a brain computed tomography scan which was carried out after recovery of spontaneous circulation (ROSC) revealed a subarachnoid hemorrhage (SAH; Fisher group 3) and brain swelling. After admission, the elevated intracerebral pressure (ICP) was controlled by moderate hypothermia (34degreesC). On the day after admission, the light reflex appeared and electroencephalography showed burst and suppression. Cerebral angiography indicated a ruptured anterior communicating artery aneurysm and an unruptured aneurysm located at the basilar tip. Neck clipping of the aneurysms was performed under moderate hypothermia (32degreesC). During the surgical procedure, the degree of brain swelling was sufficiently moderate to allow clipping of the aneurysms. After the operation, the patient was gradually rewarmed. Now with severe disability, she was moved to another hospital. Aneurysmal SAH is one of the most common causes of CPA, but survival of SAH patients after CPA is rare. In this case, ICP was controlled under moderate hypothermia and clipping of the aneurysms was performed. Moderate hypothermia is considered an attractive treatment strategy for ruptured aneurysms.