Evidence-Based Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage English Edition

Houkin, Kiyohiro; Kawase, Takeshi; Kayama, Takamasa; Kinouchi, Hiroyuki; Kirino, Takaaki; Kohmura, Eiji; Miyamoto, Susumu; Nagata, Isamu; Saeki, Naokatsu; Saito, Isamu; Saito, Nobuhito; Sakai, Nobuyuki; Sano, Hirotoshi; Sasaki, Tomio; Shiokawa, Yoshiaki; Takahashi, Akira; Taki, Waro; Taneda, Mamoru; Tominaga, Teiji; Ueshima, Hirotsugu; Yamada, Keiko; Yamaguchi, Takenori; Yamaura, Akira; Yoshida, Jun; Fujinaka, Toshiyuki; Nakamura, Hajime; Ezura, Masayuki; Fujimura, Miki; Fujita, Atsushi; Furuya, Kazuhide; Hattori, Kenichi; Iihara, Koji; Inoue, Takashi; Kakizawa, Yukinari; Kashimura, Hiroshi; Kataoka, Keisuke; Kitagawa, Naoki; Kobayashi, Eiichi; Kondo, Rei; Kurita, Hiroki; Mase, Mitsuhito; Miyachi, Shigeru; Morita, Akio; Nagata, Shinji; Nonaka, Tadashi; Nozaki, Kazuhiko; Okamoto, Sho; Okamura, Tomio; Ono, Shigeki; Onozuka, Satoshi; Otsubo, Ryoichi; Sakaida, Hiroshi; Sugita, Michiaki; Takagi, Yasushi; Umemura, Atsushi; Shimizu, Hiroaki

doi:10.2176/nmc.52.355

Cited by 37 publications

(7 citation statements)

References 252 publications

(61 reference statements)

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“…Previously reported strategies for preventing DCI have included accelerating clot clearance by administering subarachnoid fibrinolytic drugs, lumbar drainage, fenestration of the lamina terminalis, subarachnoid space lavage, and head shaking [12, 37-39, 80, 85, 86]. While most published guidelines do not comment on or recommend lumbar drainage, guidelines from Japan mention that intrathecal tPA or cisternal urokinase irrigation are useful based on moderate evidence [86]. Currently, there are promising RCTs investigating the usefulness of fibrinolytic drugs and lumbar drainage in the post-SAH setting, although they will require further assessment in future RCTs with larger sample sizes [87][88][89].…”

Section: Preventionmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Neifert

Chapman

Martini

et al. 2020

Transl. Stroke Res.

211

170

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Aneurysmal subarachnoid hemorrhage (SAH) affects six to nine people per 100,000 per year, has a 35% mortality, and leaves many with lasting disabilities, often related to cognitive dysfunction. Clinical decision rules and more sensitive computed tomography (CT) have made the diagnosis of SAH easier, but physicians must maintain a high index of suspicion. The management of these patients is based on a limited number of randomized clinical trials (RCTs). Early repair of the ruptured aneurysm by endovascular coiling or neurosurgical clipping is essential, and coiling is superior to clipping in cases amenable to both treatments. Aneurysm repair prevents rebleeding, leaving the most important prognostic factors for outcome early brain injury from the hemorrhage, which is reflected in the neurologic condition of the patient, and delayed cerebral ischemia (DCI). Observational studies suggest outcomes are better when patients are managed in specialized neurologic intensive care units with inter-or multidisciplinary clinical groups. Medical management aims to minimize early brain injury, cerebral edema, hydrocephalus, increased intracranial pressure (ICP), and medical complications. Management then focuses on preventing, detecting, and treating DCI. Nimodipine is the only pharmacologic treatment that is approved for SAH in most countries, as no other intervention has demonstrated efficacy. In fact, much of SAH management is derived from studies in other patient populations. Therefore, further study of complications, including DCI and other medical complications, is needed to optimize outcomes for this fragile patient population.

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Section: Preventionmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Neifert

Chapman

Martini

et al. 2020

Transl. Stroke Res.

211

170

View full text Add to dashboard Cite

show abstract

“…The present guidelines for the management of SAH do not specify the target PaCO 2 level [17, 18]. Recently, a phase I study involving poor-grade SAH patients demonstrated that CBF increased after controlled hypercapnia by up to 60 mmHg, even during periods of vasospasm [10].…”

Section: Introductionmentioning

confidence: 99%

Association of abnormal carbon dioxide levels with poor neurological outcomes in aneurysmal subarachnoid hemorrhage: a retrospective observational study

et al. 2018

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BackgroundIn patients with aneurysmal subarachnoid hemorrhage (SAH), an association between hypocapnia and poor clinical outcomes has been reported. However, the optimal arterial carbon dioxide tension (PaCO2) remains unknown. The present retrospective study aimed to examine the association of abnormal PaCO2 levels with neurological outcomes and investigate the optimal target PaCO2 level in patients with SAH.MethodsWe retrospectively selected consecutive adult patients hospitalized in the intensive care unit (ICU) for SAH between January 2009 and April 2017. Univariate and multivariate analyses were performed to identify the independent predictors of unfavorable neurological outcomes (i.e., modified Rankin scale score of 3–6 on hospital discharge).ResultsAmong 158 patients with SAH, 73 had unfavorable neurological outcomes. During the first 2 weeks in the ICU, the median number of PaCO2 measurements per patient was 43. The factors significantly associated with unfavorable neurological outcomes were age, Hunt and Kosnik grade, maximum lactate levels during the first 24 h, and maximum (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.03–1.21; p < 0.01) and minimum PaCO2 levels (OR, 0.81; 95% CI, 0.72–0.92; p < 0.01). Receiver operating characteristic curve analysis revealed that the cutoff range of PaCO2 was 30.2–48.3 mmHg. Unfavorable neurological outcomes were noted in 78.8% of patients with PaCO2 levels outside this range and in 22.8% of patients with PaCO2 levels within this range.ConclusionsBoth the maximum and minimum PaCO2 levels during ICU management in patients with SAH were significantly associated with unfavorable neurological outcomes. Further prospective studies are required to validate our findings and explore their clinical implications. Our findings may provide a scientific rationale for these future prospective studies.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0353-1) contains supplementary material, which is available to authorized users.

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“…CV refers to a transient, self-limited narrowing of the intracranial arteries, which typically occurs between 4 and 14 days after an aSAH ( 4 ). CV can affect up to 30~40% of patients with aSAH, and it is associated with delayed cerebral ischemia (DCI) in 20~30% of cases ( 5 , 6 ). Although the exact pathophysiology of CV remains unclear, inflammatory reaction might play an important role in the development of CV and DCI ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical relevance of serum procalcitonin in patients with aneurysmal subarachnoid hemorrhage

Kim

et al. 2022

Exp Ther Med

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Cerebral vasospasm (CV), which is closely related to the prognosis of aneurysmal subarachnoid hemorrhage (aSAH), is known to be related to an inflammatory reaction. The aim of the present study was to investigate predictable values of procalcitonin (PCT) for systemic infection and the development of CV in patients with aSAH. Patients who underwent endovascular treatment for aSAH were retrospectively enrolled. Receiver operating characteristic curve analysis was performed to evaluate the predicable value of PCT for systemic infection and CV in patients with aSAH. To clarify the association of PCT and CV, additional subgroup analysis was performed for patients without systemic infection. Multivariate logistic regression was used to explore the associations of PCT and the development of CV. A total of 374 patients with aSAH were enrolled. Of them, 164 (43.9%) had systemic infection. Optimal cutoff value of PCT for systemic infection was 0.21 ng/ml (P<0.001). In subgroup analysis of 210 patients without infection, 0.09 ng/ml of PCT level was defined as the optimal cutoff value for predicting CV after aSAH (P<0.001). In multivariate logistic regression analysis, PCT was a significant predicting factor for CV (odds ratio, 1.82; 95% confidence interval, 1.42-2.96; P=0.015). Overall, PCT had predictable value for systemic infection and the development of CV in patients who underwent endovascular treatment for aSAH. Further studies are needed to validate our results and establish its clinical applicability.

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Evidence-Based Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage English Edition

Cited by 37 publications

References 252 publications

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Aneurysmal Subarachnoid Hemorrhage: the Last Decade

Association of abnormal carbon dioxide levels with poor neurological outcomes in aneurysmal subarachnoid hemorrhage: a retrospective observational study

Clinical relevance of serum procalcitonin in patients with aneurysmal subarachnoid hemorrhage

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