The Incidence And Impact Of Secondary Cerebral Insults On Outcome Following Aneurysmal Subarachnoid Hemorrhage.

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The Incidence And Impact Of Secondary Cerebral Insults On Outcome Following Aneurysmal Subarachnoid Hemorrhage.

World Neurosurg. 2018 Mar 21;:

Authors: Doerfler S, Faerber J, McKhann GM, Elliott JP, Winn HR, Kumar M, Levine J, Le Roux PD

Abstract
INTRODUCTION: Secondary cerebral insults can adversely impact patients with traumatic brain injury. By contrast, the incidence of secondary cerebral insults after aneurysmal subarachnoid hemorrhage (SAH) and their impact on outcome have been less well studied.
METHODS: Four hundred and twenty one SAH patients who underwent surgical occlusion of their ruptured aneurysm and who received ICU care for ≥48 hours were retrospectively identified from a prospective observational database. Patients were managed according to standard recommendations for SAH. Three secondary cerebral insults were examined: hypotension (<90mmHg systolic), hypoxia (PaO2<60mmHg) and hyperglycemia (>200mg/dl).
RESULTS: A secondary cerebral insult was observed in 309 (73.4%) patients including 135 (32.1%) who had multiple insults. There was an association between worse clinical grade and development of secondary insults (p=0.0002), particularly multiple insults (p <0.0001). When stratified by clinical grade, single (adjusted OR=2.23, 95%CI 1.10-4.51, p=0.026) and multiple secondary cerebral insults (adjusted OR 4.37, 95%CI 2.14-8.93; p < 0.0001) were associated with worse outcome. In multivariate analysis and controlling for age, admission clinical grade, severity of SAH on CT, intracerebral hematoma, elevated ICP (> 20mmHg) rebleed, intra-operative rupture and hydrocephalus, secondary cerebral insults were independently associated with poor outcome (Adjusted OR=2.45; 95% CI 1.20-5.02; p=0.014).
CONCLUSIONS: Secondary cerebral insults (hypoxia, hypotension, hyperglycemia) are common after SAH, including among patients in good clinical grade. These insults after SAH are associated with worse outcome. These data suggest that prevention of secondary cerebral insults may provide an opportunity to improve patient outcome after SAH.

PMID: 29574224 [PubMed - as supplied by publisher]

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