Adherence to evidence-based processes of care reduces one-year mortality after aneurysmal subarachnoid hemorrhage (aSAH)

A cerebral aneurysm is an outpouching of a weakened arterial wall, usually at a bifurcation of one of the larger vessels of the Circle of Willis. When the outpouching ruptures, arterial pressure forces blood into the subarachnoid space. The annual incidence of aneurysmal subarachnoid hemorrhage is 8 to 10 per 100 000 in the United States. The outcome varies for this patient population. New management strategies have emerged; some practices are evidence based, whereas others are based on anecdotal experiences. This variation has resulted in a number of unresolved issues in caring for patients with an aneurysmal subarachnoid hemorrhage. This article discusses some of these unresolved issues, including the use of medications such as nimodipine, antifibrinolytics, statins, and magnesium; coiling or clipping for aneurysm securement; and the prevention and treatment of potential complications. Critical care nurses must conduct detailed assessments and provide complex care to optimize patient outcomes.

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Abstract P39: Outcomes Across the Course of Recovery From Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p39 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Sean Neifert ◽

Alexander Schupper ◽

William Shuman ◽

Michael Martini ◽

Emily Chapman ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Secondary Analysis ◽

Small Samples ◽

Individual Data ◽

Chi Square ◽

Entire Cohort ◽

One Year ◽

Time Frames ◽

Time Point

Introduction: Data on progression of recovery after aneurysmal subarachnoid hemorrhage (aSAH) is rare and limited to small samples. We sought to characterize recovery after SAH in a secondary analysis of six SAH trials. Methods: Individual data on 3,717 patients from CONSCIOUS-1, ISAT, IHAST, trials of erythropoietin and statins, NEWTON-1, and NEWTON-2 was included. Outcome was described with the Glasgow Outcomes Scale (GOS). Proportions of GOS scores between the first and second time-point were compared using chi-square tests. Rates of improvement (final GOS > initial GOS), no change (final GOS = initial GOS), and worsening (final GOS < initial GOS) and the differences between initial and final GOS scores were calculated. Results: There were improvements in outcomes across the entire cohort (p<0.001) and from 30 days to three months (p<0.001), discharge to three months (p<0.001), six weeks to three months (p<0.001), and two months to one year (p<0.001). 907 (26%) of patients improved their outcome, while 2,228 (64%) had no change and 336 (9.7%) worsened. Of the 907 who improved, 773 (85%) improved by one GOS point, 128 (14%) improved by two points, and six (0.7%) improved by three points. Of patients with initial GOS scores of 2, 62 (38%) remained unchanged, while 91 (55%) improved and 11 (6.7%) died. Patient cohorts with initial WFNS grades of 1 (p<0.001), 2 (p<0.001), 3 (p=0.004), and 4 (p<0.001) improved their GOS scores. Conclusions: Across most time-frames, many SAH patients can be expected to recover, while a few will regress. Furthermore, even patients with the poorest initial neurological grades and outcomes showed improvement.

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Neurocritical care complications and interventions influence the outcome in aneurysmal subarachnoid hemorrhage

BMC Neurology ◽

10.1186/s12883-021-02054-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alexander Hammer ◽

Frank Erbguth ◽

Matthias Hohenhaus ◽

Christian M. Hammer ◽

Hannes Lücking ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Decompressive Craniectomy ◽

Odds Ratio ◽

Neurocritical Care ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Binary Logistic Regression ◽

World Federation ◽

Binary Logistic Regression Model ◽

One Year ◽

The Impact

Abstract Background This observational study was performed to show the impact of complications and interventions during neurocritical care on the outcome after aneurysmal subarachnoid hemorrhage (SAH). Methods We analyzed 203 cases treated for ruptured intracranial aneurysms, which were classified regarding clinical outcome after one year according to the modified Rankin Scale (mRS). We reviewed the data with reference to the occurrence of typical complications and interventions in neurocritical care units. Results Decompressive craniectomy (odds ratio 21.77 / 6.17 ; p < 0.0001 / p = 0.013), sepsis (odds ratio 14.67 / 6.08 ; p = 0.037 / 0.033) and hydrocephalus (odds ratio 3.71 / 6.46 ; p = 0.010 / 0.00095) were significant predictors for poor outcome and death after one year beside “World Federation of Neurosurgical Societies” (WFNS) grade (odds ratio 3.86 / 4.67 ; p < 0.0001 / p < 0.0001) and age (odds ratio 1.06 / 1.10 ; p = 0.0030 / p < 0.0001) in our multivariate analysis (binary logistic regression model). Conclusions In summary, decompressive craniectomy, sepsis and hydrocephalus significantly influence the outcome and occurrence of death after aneurysmal SAH.

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Impact of early mobilization and rehabilitation on global functional outcome one year after aneurysmal subarachnoid hemorrhage

Journal of Rehabilitation Medicine ◽

10.2340/16501977-2121 ◽

2016 ◽

Vol 48 (8) ◽

pp. 676-682 ◽

Cited By ~ 5

Author(s):

T Karic ◽

C RÃ¸e ◽

T Nordenmark ◽

F Becker ◽

A Sorteberg

Keyword(s):

Subarachnoid Hemorrhage ◽

Functional Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Early Mobilization ◽

One Year

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Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage

Journal of Neurology ◽

10.1007/s00415-008-0047-z ◽

2008 ◽

Vol 255 (11) ◽

pp. 1770-1776 ◽

Cited By ~ 34

Author(s):

M. Ørbo ◽

K. Waterloo ◽

A. Egge ◽

J. Isaksen ◽

T. Ingebrigtsen ◽

...

Keyword(s):

Cognitive Impairment ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

One Year

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Long-term Excess Mortality of 244 Familial and 1502 Sporadic One-Year Survivors of Aneurysmal Subarachnoid Hemorrhage Compared With a Matched Eastern Finnish Catchment Population

Neurosurgery ◽

10.1227/neu.0b013e3181ff33ca ◽

2011 ◽

Vol 68 (1) ◽

pp. 20-27 ◽

Cited By ~ 25

Author(s):

Terhi. Huttunen ◽

Mikael. von und zu Fraunberg ◽

Timo. Koivisto ◽

Antti. Ronkainen ◽

Jaakko. Rinne ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Glasgow Outcome Scale ◽

Excess Mortality ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Relative Survival ◽

Survival Ratio ◽

Catchment Population ◽

One Year ◽

The Impact

Abstract BACKGROUND: Saccular intracranial aneurysms (sIAs) develop in 2% of the population. Rupture of the sIA wall causes almost all cases of aneurysmal subarachnoid hemorrhage (aSAH). OBJECTIVE: We analyzed the long-term excess mortality of 244 familial and 1502 sporadic 1-year survivors of aSAH from sIA compared with a matched Eastern Finnish catchment population. METHODS: The Kuopio Neurosurgery Database contains 1746 one-year survivors of aSAH (1980–2007) from a defined population. The median follow-up time, until death (n = 494) or the end of 2008, was 12 years. Relative survival ratios were calculated compared with the matched (sex, age, calendar time) catchment population. Relative excess risk of death (RER) was estimated for variables known on admission for aSAH as well as Glasgow Outcome Scale score at 12 months. RESULTS: There was 12% excess mortality at 15 years (cumulative relative survival ratio: 0.88; 95% confidence interval: 0.85-0.91). Independent risk factors were male sex (RER: 1.6), age older than 64 years (RER: 2.9), ruptured basilar tip sIA (RER: 4.5), severe hydrocephalus on admission (RER: 3.6), no occlusive therapy (RER: 6.0), and Glasgow Outcome Scale scores of 2, 3, or 4 at 12 months (RER: 23, 4.1, 2.1, respectively), but not familial sIA disease. There were lethal rebleeds from 13 of the 1440 clipped sIAs, 2 of the 265 coiled sIAs, and 2 from the 17 nonoccluded sIAs, and 14 new lethal bleeds from other sIAs. CONCLUSION: The impact of both sporadic and familial aSAH and their sequelae in the central nervous and cardiovascular systems may cause long-term morbidity and mortality. The complex sIA disease may predispose to other vascular events later in life. The causes of the long-term excess mortality are heterogeneous, and more detailed analyses are required.

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