Mitigation of Blood Load Impact in Patients with Subarachnoid Hemorrhage by Cisternal Lavage

2022 ◽  
pp. 1-7
Author(s):  
Panagiotis Fistouris ◽  
Christian Scheiwe ◽  
Juergen Grauvogel ◽  
István Csók ◽  
Juergen Beck ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Prognostic Significance ◽  
Study Groups ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome ◽  
Risk Patients ◽  
Multivariable Regression ◽  
Comorbidity Index ◽  
Multivariable Regression Models

<b><i>Object:</i></b> The initial amount of subarachnoid and ventricular blood is an important prognostic factor for outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this comparative study of an unselected aSAH-population, we assess the modifiability of these factors by implementation of blood clearance by cisternal lavage. <b><i>Methods:</i></b> All patients with aSAH treated in our department between October 2011 and October 2019 (8 years, <i>n</i> = 458) were included in our study. In the first 4-year period (BEFORE, <i>n</i> = 237), patients were treated according to international guidelines. In the second 4-year period (AFTER, <i>n</i> = 221), cisternal lavage methods were available and applied in 72 high-risk patients (32.5%). The cisternal and ventricular blood load was recorded by the Hijdra score. Multivariable regression models were used to assess the prognostic significance of risk factors, including blood load, in relation to common aSAH characteristics in both study groups. <b><i>Results:</i></b> Worse neurological outcomes (mRS &#x3e; 3) occurred in the BEFORE population with 41.45% versus 30.77% in the AFTER cohort, 6 months after aSAH (HR: 1.59, 95% CI 1.08–2.34, <i>p</i> = 0.01). Admission WFNS grade, comorbidities (Charlson Comorbidity Index), herniation signs, concomitant intracerebral hemorrhage, and the development of delayed cerebral infarction were strongly associated with poor outcome in both study groups. Intraventricular and cisternal blood load and, particularly, a cast fourth ventricle (Cast 4) represented strong prognosticators of poor neurological outcome in the BEFORE cohort. This effect was lost after implementation of cisternal lavage (AFTER cohort). <b><i>Conclusion:</i></b> Cisternal and ventricular blood load – in particular: a Cast 4 – represent important prognosticators in patients with aSAH. They are, however, amenable to modification by blood clearing therapies.

Saccular aneurysms in the post–Barrow Ruptured Aneurysm Trial era

2021 ◽  
pp. 1-8
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Kavelin Rumalla ◽  
...  
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Endovascular Embolization ◽  
Endovascular Intervention ◽  
Ruptured Aneurysm ◽  
Endovascular Coiling ◽  
Neurological Outcomes ◽  
Microsurgical Clipping ◽  
Poor Neurological Outcome ◽  
Technical Advances ◽  
Saccular Aneurysms

OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial that compared endovascular coiling to microsurgical clipping in patients treated for aneurysmal subarachnoid hemorrhage (aSAH). However, because patients in the BRAT were treated more than 15 years ago, and because there have been advances since then—particularly in endovascular techniques—the relevance of the BRAT today remains controversial. Some hypothesize that these technical advances may reduce retreatment rates for endovascular intervention. In this study, the authors analyzed data for the post-BRAT (PBRAT) era to compare microsurgical clipping with endovascular embolization (coiling and flow diverters) in the two time periods and to examine how the results of the original BRAT have influenced the practice of neurosurgeons at the study institution. METHODS In this retrospective cohort study, the authors evaluated patients with saccular aSAHs who were treated at a single quaternary center from August 1, 2007, to July 31, 2019. The saccular aSAH diagnoses were confirmed by cerebrovascular experts. Patients were separated into two cohorts for comparison on the basis of having undergone microsurgery or endovascular intervention. The primary outcome analyzed for comparison was poor neurological outcome, defined as a modified Rankin Scale (mRS) score > 2. The secondary outcomes that were compared included retreatment rates for both therapies. RESULTS Of the 1014 patients with aSAH during the study period, 798 (79%) were confirmed to have saccular aneurysms. Neurological outcomes at ≥ 1-year follow-up did not differ between patients treated with microsurgery (n = 451) and those who received endovascular (n = 347) treatment (p = 0.51). The number of retreatments was significantly higher among patients treated endovascularly (32/347, 9%) than among patients treated microsurgically (6/451, 1%) (p < 0.001). The retreatment rate after endovascular treatment was lower in the PBRAT era (9%) than in the BRAT (18%). CONCLUSIONS Similar to results from the BRAT, results from the PBRAT era showed equivalent neurological outcomes and increased rates of retreatment among patients undergoing endovascular embolization compared with those undergoing microsurgery. However, the rate of retreatment after endovascular intervention was much lower in the PBRAT era than in the BRAT.

Abstract 2792: Cardiac Complications After Aneurysmal Subarachnoid Hemorrhage Are Associated With Outcome: A Meta-analysis

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Ivo A van der Bilt ◽  
Djo Hasan ◽  
W. P Vandertop ◽  
Arthur A Wilde ◽  
Ale Algra ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Delayed Cerebral Ischemia ◽  
Myocardial Damage ◽  
Future Research ◽  
Cardiac Complications ◽  
Pathophysiological Mechanism ◽  
Cardiac Abnormalities

Cardiac complications after subarachnoid hemorrhage (SAH) occur frequently, but their prognostic significance remains unclear. We performed a meta-analysis to assess whether echocardiographic wall motion abnormalities (WMA), electrocardiographic (ECG) changes, or elevated markers for myocardial damage are related to the occurrence of delayed cerebral ischemia (DCI) or death. Methods All articles that reported on cardiac abnormalities after aneurysmal SAH, that met predefined criteria, and were published between 1960 and 2007 were assessed. Data were extracted on predefined methodological criteria, patient characteristics, prevalence of cardiac abnormalities, and DCI or death. We calculated pooled relative risks (RR) with corresponding 95% confidence intervals (CI) for the separate cardiac abnormalities and outcome. Results We included 25 studies (16 prospective), comprising 2690 patients (mean age 53 years; 35% was male). The figure shows the univariable RRs of the determinants for death. For DCI we found a significant association with WMA (RR 2.10 [CI 1.17, 3.78]); Troponin RR 3.15 [CI 2.27, 4.38]; CK-MB RR: 2.90 [CI 1.86, 4.52]; BNP RR: 4.52 [CI 1.79, 11.39]; and ST depression RR: 2.40 [CI 1.2, 4.9]. No significant associations were found for DCI and ST elevation RR: 2.1 [CI 0.7, 5.7]; T wave abnormality RR: 0.9 [CI 0.5, 1.7]; U wave RR: 0.7 [CI 0.4, 1.3] or prolonged QT RR: 1.0 [CI 0.5, 2.3]. Conclusion Cardiac abnormalities increase the risk of DCI and death after SAH. Future research should be directed towards elucidating the multivariable relationship between the cardiac prognosticators, the pathophysiological mechanism and potential treatment options.

scholarly journals Predictors of the development of takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage and outcomes in patients with intra-aortic balloon pumps

2020 ◽  
pp. 1-6
Author(s):  
Joshua S. Catapano ◽  
Andrew F. Ducruet ◽  
Fabio A. Frisoli ◽  
Candice L. Nguyen ◽  
Christopher E. Louie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Takotsubo Cardiomyopathy ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
High Morbidity ◽  
Female Patients ◽  
Neurological Outcomes ◽  
Poor Outcomes

OBJECTIVETakotsubo cardiomyopathy (TC) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity and mortality. Previous studies have shown that female patients presenting with a poor clinical grade are at the greatest risk for developing TC. Intra-aortic balloon pumps (IABPs) are known to support cardiac function in severe cases of TC, and they may aid in the treatment of vasospasm in these patients. In this study, the authors investigated risk factors for developing TC in the setting of aSAH and outcomes among patients requiring IABPs.METHODSThe authors retrospectively reviewed the records of 1096 patients who had presented to their institution with aSAH. Four hundred five of these patients were originally enrolled in the Barrow Ruptured Aneurysm Trial, and an additional 691 patients from a subsequent prospectively maintained aSAH database were analyzed. Medical records were reviewed for the presence of TC according to the modified Mayo Clinic criteria. Outcomes were determined at the last follow-up, with a poor outcome defined as a modified Rankin Scale (mRS) score > 2.RESULTSTC was identified in 26 patients with aSAH. Stepwise multivariate logistic regression analysis identified female sex (OR 8.2, p = 0.005), Hunt and Hess grade > III (OR 7.6, p < 0.001), aneurysm size > 7 mm (OR 3, p = 0.011), and clinical vasospasm (OR 2.9, p = 0.037) as risk factors for developing TC in the setting of aSAH. TC patients, even with IABP placement, had higher rates of poor outcomes (77% vs 47% with an mRS score > 2, p = 0.004) and mortality at the last follow-up (27% vs 11%, p = 0.018) than the non-TC patients. However, aggressive intra-arterial endovascular treatment for vasospasm was associated with good outcomes in the TC patients versus nonaggressive treatment (100% with mRS ≤ 2 at last follow-up vs 53% with mRS > 2, p = 0.040).CONCLUSIONSTC after aSAH tends to occur in female patients with large aneurysms, poor clinical grades, and clinical vasospasm. These patients have significantly higher rates of poor neurological outcomes, even with the placement of an IABP. However, aggressive intra-arterial endovascular therapy in select patients with vasospasm may improve outcome.

scholarly journals Impact of Hyperoxia and Hypocapnia on Neurological Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Kin Chio Li ◽  
Catherine Wing Yan Tam ◽  
Hoi-Ping Shum ◽  
Wing Wa Yan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Critically Ill ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Classification Tree ◽  
Tertiary Hospital ◽  
Classification Tree Analysis ◽  
Radiological Findings ◽  
Neurological Outcomes ◽  
Poor Outcomes ◽  
The Impact

In recent decades, there is increasing evidence suggesting that hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with cardiac arrest or traumatic brain injury. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been well studied. In the present study, we evaluated the impact of hyperoxia and hypocapnia on neurological outcomes in patients with aneurysmal SAH (aSAH). Patients with aSAH who were admitted to the intensive care unit (ICU) of a tertiary hospital in Hong Kong between January 2011 and December 2016 were retrospectively recruited. Patients’ demographics, comorbidities, radiological findings, clinical grades of SAH, PO2, and PCO2 within 24 hours of ICU admission, and Glasgow Outcome Scale (GOS) at 3 months after admission were recorded. Patients with a GOS score of 3 or less were considered having poor neurological outcomes. Among the 244 patients with aSAH, 122 of them (50%) had poor neurological outcomes at 3 months. Early hyperoxia (PO2 > 200 mmHg) and hypercapnia (PCO2 > 45 mmHg) were more common among patients with poor neurological outcomes. Logistic regression analysis indicated that hyperoxia independently predicted poor neurological outcomes (OR 3.788, 95% CI 1.131–12.690, P=0.031). Classification tree analysis revealed that hypocapnia was associated with poor neurological outcomes in patients who were less critically ill (APACHE < 50) and without concomitant intracranial hemorrhage (ICH) or intraventricular hemorrhage (IVH) (adjusted P=0.006, χ2 = 7.452). These findings suggested that hyperoxia and hypocapnia may be associated with poor neurological outcomes in patients with aSAH.

scholarly journals Prevalence and predictors of fatigue after aneurysmal subarachnoid hemorrhage

2020 ◽  
Vol 162 (12) ◽  
pp. 3107-3116
Author(s):  
Elin Western ◽  
Angelika Sorteberg ◽  
Cathrine Brunborg ◽  
Tonje Haug Nordenmark
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Acute Phase ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariable Analysis ◽  
Chronic Phase ◽  
Common Denominator ◽  
Fatigue Severity ◽  
Multivariable Regression ◽  
Subarachnoid Blood ◽  
Aneurysm Repair

Abstract Background Fatigue is a common and disabling sequel after aneurysmal subarachnoid hemorrhage (aSAH). At present, prevalence estimates of post-aSAH fatigue in the chronic phase are scarce and vary greatly. Factors from the acute phase of aSAH have hitherto barely been associated with post-aSAH fatigue in the chronic phase. Methods Prospective study assessing prevalence of fatigue using the Fatigue Severity Scale (FSS) in patients who were living independently 1 to 7 years after aSAH. We compared demographic, medical, and radiological variables from the acute phase of aSAH between patients with and without fatigue (FSS ≥ 4 versus < 4) and searched for predictors of fatigue among these variables applying univariable and multivariable regression analyses. Results Of 726 patients treated for aSAH in the period between January 2012 and December 2017, 356 patients completed the assessment. The mean FSS score was 4.7 ± 1.7, and fatigue was present in 69.7%. The frequency of patients with fatigue did not decline significantly over time. Univariable analysis identified nicotine use, loss of consciousness at ictus (LOCi), rebleed prior to aneurysm repair, reduced consciousness to Glasgow Coma Scale (GCS) < 14, large amounts of subarachnoid blood, the presence of acute hydrocephalus, and severe vasospasm as factors that were significantly associated with fatigue. In multivariable analysis, nicotine use, reduced GCS, and severe vasospasm were independent predictors that all more than doubled the risk to develop post-aSAH fatigue. Conclusions Fatigue is a frequent sequel persisting several years after aSAH. Nicotine use, reduced consciousness at admission, and severe vasospasm are independent predictors of fatigue from the acute phase of aSAH. We propose inflammatory cytokines causing dopamine imbalance to be a common denominator for post-aSAH fatigue and the presently identified predictors.

Prognostic Significance of Hypernatremia and Hyponatremia among Patients with Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 749-756 ◽  
Author(s):  
Adnan I. Qureshi ◽  
M. Fareed K. Suri ◽  
Gene Y. Sung ◽  
Robert N. Straw ◽  
Abutaher M. Yahia ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Prognostic Significance

QTc Interval and Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage

2010 ◽  
Vol 13 (3) ◽  
pp. 347-354 ◽  
Author(s):  
Taiga Ichinomiya ◽  
Yoshiaki Terao ◽  
Kosuke Miura ◽  
Ushio Higashijima ◽  
Tomomi Tanise ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Qtc Interval ◽  
Neurological Outcomes

Inflammation-based scores are associated with prognosis of patients with aneurysmal subarachnoid hemorrhage after neuro-intervention

2020 ◽  
Vol 17 ◽  
Author(s):  
Ho Jun Yi ◽  
Dong Hoon Lee ◽  
Jae Hoon Sung
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Prognostic Significance ◽  
Density Lipoprotein ◽  
Endovascular Intervention ◽  
Roc Curve Analysis ◽  
Lymphocyte To Monocyte Ratio ◽  
Cutoff Values ◽  
The Relationship

Objective: Prognostic significance of inflammatory response has been reported in various diseases. The objective of this study was to analyze the association between inflammation-based scores and prognosis of patients who underwent neuro-intervention for aneurysmal subarachnoid hemorrhage (SAH). Methods: Inflammation-based scores such as neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) were analyzed for aneurysmal SAH patients Results: A total of 498 patients were enrolled. Optimal cutoff values of inflammation-based scores of NLR, LMR, and MHR for unfavorable functional outcome were 5.7, 4.2, and 1.5, respectively (p < 0.001, < 0.001, and 0.004, respectively). In multivariate analysis, NLR value ≥ 5.7 (odds ratio [OR] 1.92, 95% CI 1.42–3.42; P = 0.008), LMR value < 4.2 (OR 1.74, 95% CI 1.48–2.98; P = 0.018), and MHR value ≥ 1.5 (OR 1.44, 95% CI 1.22–2.82; P = 0.040) were independently associated with unfavorable functional outcome. Conclusion: Inflammation based scores were associated with functional outcome after endovascular intervention for aneurysmal SAH. Higher NLR and MHR with lower LMR could predict unfavorable outcomes of aneurysmal SAH patients who underwent endovascular intervention. who underwent endovascular intervention. Unfavorable functional outcome was defined as modified Rankin Scale (mRS) score of 3-6. Receiver operating characteristic (ROC) curve analysis was performed to identify cutoff values of inflammation- based scores for predicting unfavorable functional outcome. Logistic regression analyses were performed to explore the relationship between inflammation-based scores and prognosis of patients.

Blood Glucose Variability: A Strong Independent Predictor of Neurological Outcomes in Aneurysmal Subarachnoid Hemorrhage

2016 ◽  
Vol 33 (3) ◽  
pp. 189-195 ◽  
Author(s):  
Tomoya Okazaki ◽  
Toru Hifumi ◽  
Kenya Kawakita ◽  
Hajime Shishido ◽  
Daisuke Ogawa ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Subarachnoid Hemorrhage ◽  
Glucose Level ◽  
Neurological Outcome ◽  
Independent Predictor ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Glucose Variability ◽  
Independent Effect ◽  
Neurological Outcomes ◽  
Mean Glucose

Purpose: In patients with aneurysmal subarachnoid hemorrhage (SAH), increased glucose variability (GV) is associated with increased mortality and cerebral infarction; however, there are no reports demonstrating an association between GV and neurological outcome. This study investigated whether GV had an independent effect on neurological outcomes in patients with SAH in the intensive care unit. Materials and Methods: Consecutive adult patients hospitalized with SAH between January 1, 2009, and May 31, 2015 (N = 122) were retrospectively reviewed. Univariate/multivariate analyses were performed to identify independent predictors of poor neurological outcome. Patients were divided according to the mean glucose level (80-139 vs 140-200 mg/dL) and further subdivided using quartiles (Q) of the standard deviation (SD, representing variability) of the glucose level (Q1, Q2 + 3, and Q4). Results: Unfavorable neurological outcomes occurred in 44.2% of the patients. On multiple regression analysis, age, Hunt and Kosnik grade, SD of glucose (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.02-1.17; P < .01), and minimum blood glucose level (OR, 0.95; 95% CI, 0.91-0.99; P < .01) were significantly associated with unfavorable neurological outcomes. Both groups (mean glucose levels: 80-139 and 140-200 mg/dL groups) had increasing unfavorable neurological outcomes with increasing SD of glucose (Q1, 15.0%; Q2 + 3, 40.0%; Q4, 52.4% and Q1, 44.4%; Q2 + 3, 50%; Q4, 88.9% in the 80-139 and 140-200 mg/dL groups, respectively). Patients with minimum glucose of <90 mg/dL comprised >50% of unfavorable neurological outcome. Conclusion: Increased GV was an independent predictor of unfavorable neurological outcomes in patients with SAH.

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