Cardiac dysfunction in patients affected by subarachnoid haemorrhage affects in-hospital mortality

Abstract

BACKGROUND Subarachnoid haemorrhage (SAH) is a lifethreatening condition with associated brain damage. Moreover, SAH is associated with a massive release of catecholamines, which may promote cardiac injury and dysfunction, possibly leading to haemodynamic instability, which in turn may influence a patient's outcome.OBJECTIVES To study the prevalence of cardiac dysfunction (as assessed by echocardiography) in patients with SAH and its effect on clinical outcomes. DESIGN Systematic review of observational studies.DATA SOURCES We performed a systematic search over the last 20 years on MEDLINE and EMBASE databases.ELIGIBILITY CRITERIA Studies reporting echocardiography findings in adult patients with SAH admitted to intensive care. Primary outcomes were in-hospital mortality and poor neurological outcome according to the presence or absence of cardiac dysfunction. RESULTSWe included a total of 23 studies (4 retrospective) enrolling 3511 patients. The cumulative frequency of cardiac dysfunction was 21% (725 patients), reported as regional wall motion abnormality in the vast majority of studies (63%). Due to the heterogeneity of clinical outcome data reporting, a quantitative analysis was carried out only for in-hospital mortality. Cardiac dysfunction was associated with a higher in-hospital mortality [odds ratio 2.69 (1.64 to 4.41); P < 0.001; I 2 ¼ 63%]. The GRADE of evidence assessment resulted in very low certainty of evidence.CONCLUSION About one in five patients with SAH develops cardiac dysfunction, which seems to be associated with higher in-hospital mortality. The consistency of cardiac and neurological data reporting is lacking, reducing the comparability of the studies in this field.

Diastology in the intensive care unit: Challenges for the assessment and future directions

“…Indeed, other populations of critically ill patients have been explored, but the consistency of the results and the grade of evidence reported is very low, as in the case of cardiac dysfunction in patients affected by subarachnoid hemorrhage. 8 Recently, DD was associated with poor outcomes in sepsis, whilst the association is more unclear when looking at LV systolic dysfunction.…”

Emergent Management of Spontaneous Subarachnoid Hemorrhage

“…Neurogenic stunned myocardium is common in patients with aneurysmal SAH, with 21% to 30% of patients experiencing the onset of global or apical hypokinesis and decreased left ventricular ejection fraction. 93,94 It is associated with higher rates of delayed cerebral ischemia and poor outcome. 95 In the acute management of aneurysmal SAH, clinicians must consider the presence of neurogenic stunned myocardium in the context of choosing vasopressors, inotropes, or both in the treatment of delayed cerebral ischemia.…”

“…Neurogenic stunned myocardium is common in patients with aneurysmal SAH, with 21% to 30% of patients experiencing the onset of global or apical hypokinesis and decreased left ventricular ejection fraction 93,94 . It is associated with higher rates of delayed cerebral ischemia and poor outcome 95 .…”

Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group

“…Because of these changes, treatment and observation paths have been designed for pathologies that are also very complex or with complex management, such as, for example, severe trauma, heart failure and head trauma. [89][90][91][92][93][94][95]. Although increased crowding negatively affects patient outcomes and satisfaction, the consequences for triage-particularly on wait times and UT and OT frequency-have not yet been extensively investigated.…”