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CC BY 4.0 · J Neuroanaesth Crit Care 2024; 11(02): 100-106
DOI: 10.1055/s-0044-1787880
Original Article

Management and Outcomes of Delayed Cerebral Ischemia Associated with Vasospasm Post Nontraumatic Subarachnoid Hemorrhage: A Retrospective Cohort Study in the National Neurosurgical Center in Ireland

Patrick N. Wiseman 
1   Department of Anesthesiology and Critical Care, Beaumont Hospital, Dublin, Ireland
,
Sarah Power
2   Department of Neuroradiology, Beaumont Hospital, Dublin, Ireland
,
Stephen MacNally
3   Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
,
Deirdre Nolan
3   Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
,
Paula Corr
3   Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
,
Gerard Curley
1   Department of Anesthesiology and Critical Care, Beaumont Hospital, Dublin, Ireland
,
Caroline M. Larkin
1   Department of Anesthesiology and Critical Care, Beaumont Hospital, Dublin, Ireland
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Abstract

Background Delayed cerebral ischemia (DCI) is the leading cause of adverse outcome in patients who survive the initial phase of subarachnoid hemorrhage (SAH). While guidelines recommend induced hypertension as a first-line treatment for DCI, there is no high-level evidence confirming outcome benefit.

Methods Patients admitted with nontraumatic SAH over 3 years period were identified. Demographics, clinical/radiological presentation, aneurysm repair method, and Glasgow outcome score (GOS) 3 months postdischarge were recorded. A subgroup of patients who suffered clinically significant vasospasm were identified, and their hypertensive therapy and outcomes were examined.

Results A total of 532 patients were admitted with SAH; 68 developed vasospasm. The vasospasm subgroup was divided based on vasopressor treatment—norepinephrine alone (n = 27) versus norepinephrine plus vasopressin (n = 35). No correlation was found between percentage of days that mean arterial pressure (MAP) targets were met and GOS outcome. Patients treated with both agents had worse GOS outcomes at than those treated with norepinephrine alone.

Conclusion In our study, 12.8% of patients SAH developed vasospasm. Twenty-seven patients were treated with norepinephrine alone and 35 were treated with norepinephrine plus vasopressin to achieve augmented MAP targets. There was no correlation between percentage of days that MAP targets were met and improved patient outcome. The 68 patients stayed a total of 783 days in ICU, with a mean length of stay of 11.5 days. Patients who required dual therapy to achieve MAP targets had significantly worse neurological outcomes.

Keywords

subarachnoid hemorrhage - delayed cerebral ischemia - cerebral vasospasm - intracranial - aneurysm - hypertensive therapy


Publikationsverlauf

Artikel online veröffentlicht:
08. August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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