Background and Purpose:
Volume management is critical for the assessment of the vasospasm after aneurismal subarachnoid hemorrhage (SAH). In this study, we investigate the difference in the postoperative systemic hemodynamics between surgical clipping and endovascular coiling.
Methods:
In a multicenter prospective cohort study, multiple hemodynamic parameters were calculated by single indicator transpulmonary thermodilution system (Picco®) from day 1 to 14 in the patients with SAH.
Results:
Two hundred and four patients were enrolled in this study, and 176 patients with ruptured anterior circulation aneurysm were analyzed. Clipping was performed in 155 patients and coiling was performed in 21 patients. The patient characteristics were similar in both groups except higher preoperative grade in coiling than clipping. Regarding hematological parameters, clipping group had higher CRP and lower hemoglobin and hematocrits. Preload and afterload were similar in both groups. Coiling group had significantly less cardiac function index compared with clipping indicating that coiling was preferably selected for severe cases. Interestingly, extravascular lung water index (EVLWI) was significantly higher in clipping than coiling group without elevation of the pulmonary vascular permeability index. Moreover, elevation of Brain Natriuretic Peptide did not affect EVLWI.
Conclusions:
We first show that postoperative hemodynamics is different depending on the treatment option: clipping or coiling after aneurysmal SAH. Clipping can enhances cardiogenic lung edema due to hemodynamic stress rather than coiling. Bedside monitoring with Picco® system is a powerful tool for the volume management of patients with SAH.
Multicenter Prospective Cohort Study on Volume Management After Subarachnoid Hemorrhage: Hemodynamic Changes According to Severity of Subarachnoid Hemorrhage and Cerebral Vasospasm
