Subarachnoid Hemorrhage, Delayed Cerebral Ischemia, and Milrinone Use in Canada

Abstract

Introduction: Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI. Methods: We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative methods. Results: The response rate was 129/340 (38%). Agreement among respondents was limited to the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for the prevention of DCI. Several inconsistencies were identified. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients who felt to require IV milrinone, IA vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI. Conclusion: DCI is an important clinical entity for which no homogeneity and standardization exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the definition, identification, and treatment of DCI.

A Survey on Monitoring and Management of Cerebral Vasospasm and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage: The Mantra Study

“…More than half of the respondents worked in a hospital where a protocol for the monitoring and management of DCI related to cerebral vasospasm was available. Regarding treatment protocols, our findings are similar to those reported in a recently published Canadian survey 12 . Presumably, the institutional availability of a protocol could be helpful to improve the care of these patients, and, in this regard, more research should be encouraged.…”

“…Regarding treatment protocols, our findings are similar to those reported in a recently published Canadian survey. 12 Presumably, the institutional availability of a protocol could be helpful to improve the care of these patients, and, in this regard, more research should be encouraged.…”

Milrinone for the treatment of heart failure caused by severe Pneumonia in children with congenital heart disease: a meta-analysis

“…Compared with children with simple heart failure, the treatment of congenital heart disease with acute heart failure is more difficult [ 37 ]. When treated with digoxin, this drug mainly relieves the symptoms of congenital heart disease complicated by acute heart failure by positive inotropic action and negative frequency effect, because the myocardial cells and myocardial contractility are damaged obviously [ 38 ]. As a result, the negative frequency mechanism of digoxin is limited, so the improvement of cardiac function of some children is not good [ 39 , 40 ].…”