Acute Multidisciplinary Management of Aneurysmal Subarachnoid Hemorrhage (aSAH)

Aneurysmal subarachnoid hemorrhage is a life-threatening, neurological emergency characterized by accumulation of blood in the subarachnoid space due to a ruptured aneurysm. Over the past several decades, improvements in the clinical management of aneurysmal subarachnoid hemorrhage have led to better patient outcomes. However, aneurysmal subarachnoid hemorrhage is still associated with high morbidity and mortality. During the acute phase of aneurysmal subarachnoid hemorrhage and prior to the definitive management of the aneurysm, numerous medical emergencies, such as elevated intracranial pressure and cerebral vasospasm, must be effectively managed to ensure the best possible neurological outcome. Early and rapid open communication between the clinical specialties caring for the aneurysmal subarachnoid hemorrhage patient is vital for rapid data collection, decision-making, and definitive treatment. In this narrative review, we aim to present the current guidelines for the multidisciplinary acute management of aneurysmal subarachnoid hemorrhage.

[1]  Batya R. Radzik,et al.  532: CEREBRAL OXIMETRY-DERIVED OPTIMAL BLOOD PRESSURE TARGETS IN ANEURYSMAL SUBARACHNOID HEMORRHAGE , 2022, Critical Care Medicine.

[2]  Kun Hou,et al.  Current status of perimesencephalic non-aneurysmal subarachnoid hemorrhage , 2022, Frontiers in Neurology.

[3]  S. Hohmann,et al.  Regional Variability in the Care and Outcomes of Subarachnoid Hemorrhage Patients in the United States , 2022, Frontiers in Neurology.

[4]  T. Ala-Kokko,et al.  Trends in Mortality after Intensive Care of Patients with Aneurysmal Subarachnoid Hemorrhage in Finland in 2003–2019: A Finnish Intensive Care Consortium study , 2021, Neurocritical Care.

[5]  S. Lengyel,et al.  Takotsubo cardiomyopathy in patients suffering from acute non-traumatic subarachnoid hemorrhage—A single center follow-up study , 2021, PloS one.

[6]  A. Malhotra,et al.  Practices and Patterns of Hourly Neurochecks: Analysis of 8,936 Patients With Neurological Injury , 2021, Journal of intensive care medicine.

[7]  A. Preece,et al.  Caring for Patients with Aneurysmal Subarachnoid Hemorrhage: Nursing Perspectives from the United Kingdom. , 2021, Critical care nursing clinics of North America.

[8]  J. Vincent,et al.  Brain tissue oxygenation guided therapy and outcome in non-traumatic subarachnoid hemorrhage , 2021, Scientific Reports.

[9]  N. Ko,et al.  International Practice Variability in Treatment of Aneurysmal Subarachnoid Hemorrhage , 2021, Journal of clinical medicine.

[10]  T. Bhalla,et al.  Mechanical ventilation in aneurysmal subarachnoid hemorrhage: systematic review and recommendations , 2020, Critical Care.

[11]  V. Rohde,et al.  Mechanical Ventilation, Sedation and Neuromonitoring of Patients with Aneurysmal Subarachnoid Hemorrhage in Germany: Results of a Nationwide Survey , 2020, Neurocritical Care.

[12]  J. Teitelbaum,et al.  Milrinone for refractory cerebral vasospasm with delayed cerebral ischemia. , 2020, Journal of neurosurgery.

[13]  S. Mundiyanapurath,et al.  High-normal PaCO2 values might be associated with worse outcome in patients with subarachnoid hemorrhage – a retrospective cohort study , 2020, BMC neurology.

[14]  R. Geocadin,et al.  The Medical Management of Cerebral Edema: Past, Present, and Future Therapies , 2019, Neurotherapeutics.

[15]  C. Matouk,et al.  Deviation From Personalized Blood Pressure Targets Is Associated With Worse Outcome After Subarachnoid Hemorrhage. , 2019, Stroke.

[16]  R. Helbok,et al.  Early Brain Injury After Poor-Grade Subarachnoid Hemorrhage , 2019, Current Neurology and Neuroscience Reports.

[17]  Q. Guo,et al.  Hyperventilation in neurological patients: from physiology to outcome evidence , 2019, Current opinion in anaesthesiology.

[18]  A. Algra,et al.  Worldwide Incidence of Aneurysmal Subarachnoid Hemorrhage According to Region, Time Period, Blood Pressure, and Smoking Prevalence in the Population: A Systematic Review and Meta-analysis , 2019, JAMA neurology.

[19]  H. Marquering,et al.  Radiological scales predicting delayed cerebral ischemia in subarachnoid hemorrhage: systematic review and meta-analysis , 2019, Neuroradiology.

[20]  S. Gupta,et al.  Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services?: Study of 2000 Patients Over 2 Decades From India , 2018, Stroke.

[21]  J. Lynch,et al.  Seizure Prophylaxis in the Immediate Post-Hemorrhagic Period in Patients with Aneurysmal Subarachnoid Hemorrhage. , 2017, Journal of vascular and interventional neurology.

[22]  Hester F. Lingsma,et al.  High Early Fluid Input After Aneurysmal Subarachnoid Hemorrhage: Combined Report of Association With Delayed Cerebral Ischemia and Feasibility of Cardiac Output–Guided Fluid Restriction , 2017, Journal of intensive care medicine.

[23]  M. Hara,et al.  Comprehensive Evaluation of Diagnostic and Treatment Strategies for Idiopathic Spinal Subarachnoid Hemorrhage. , 2017, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[24]  T. Leslie-Mazwi,et al.  Management of External Ventricular Drains After Subarachnoid Hemorrhage: A Multi-Institutional Survey , 2017, Neurocritical Care.

[25]  Sameer H. Halani,et al.  Comparison Between CTA and Digital Subtraction Angiography in the Diagnosis of Ruptured Aneurysms , 2017, Neurosurgery.

[26]  C. Reis,et al.  Hydrocephalus after Subarachnoid Hemorrhage: Pathophysiology, Diagnosis, and Treatment , 2017, BioMed research international.

[27]  Odette A. Harris,et al.  Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition , 2016, Neurosurgery.

[28]  A. Arboix,et al.  Hematological disorders: a commonly unrecognized cause of acute stroke , 2016, Expert review of hematology.

[29]  B. Jankowitz,et al.  Prophylactic Antiepileptics and Seizure Incidence Following Subarachnoid Hemorrhage: A Propensity Score–Matched Analysis , 2016, Stroke.

[30]  M. Harrigan,et al.  Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. , 2016, Journal of neurosurgery.

[31]  G. Citerio,et al.  High-Resolution Intracranial Pressure Burden and Outcome in Subarachnoid Hemorrhage , 2015, Stroke.

[32]  S. Mayer,et al.  Subarachnoid hemorrhage: who dies, and why? , 2015, Critical Care.

[33]  G. Luijckx,et al.  Predictive Factors for Rebleeding After Aneurysmal Subarachnoid Hemorrhage: Rebleeding Aneurysmal Subarachnoid Hemorrhage Study , 2015, Stroke.

[34]  R. Sladen,et al.  Perioperative critical care management for patients with aneurysmal subarachnoid hemorrhage , 2014, Korean journal of anesthesiology.

[35]  T. Masuyama,et al.  Takotsubo cardiomyopathy: Pathophysiology, diagnosis and treatment. , 2014, World journal of cardiology.

[36]  P. Nelemans,et al.  Diagnosing Intracranial Aneurysms With MR Angiography: Systematic Review and Meta-Analysis , 2014, Stroke.

[37]  Michiyasu Suzuki,et al.  Multicenter Prospective Cohort Study on Volume Management After Subarachnoid Hemorrhage: Hemodynamic Changes According to Severity of Subarachnoid Hemorrhage and Cerebral Vasospasm , 2013, Stroke.

[38]  Jeffrey M Singh,et al.  Hypocapnia in Aneurysmal Subarachnoid Hemorrhage: Incidence and Association With Poor Clinical Outcomes , 2013, Journal of neurosurgical anesthesiology.

[39]  L. McCullough,et al.  Clinical characteristics and outcomes of neurogenic stress cadiomyopathy in aneurysmal subarachnoid hemorrhage , 2013, Clinical Neurology and Neurosurgery.

[40]  A. Algra,et al.  Timing of Aneurysm Treatment After Subarachnoid Hemorrhage: Relationship With Delayed Cerebral Ischemia and Poor Outcome , 2012, Stroke.

[41]  Paul Vespa,et al.  Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association , 2012, Stroke.

[42]  T. Videen,et al.  Effect of mannitol on cerebral blood volume in patients with head injury. , 2012, Neurosurgery.

[43]  R. Macdonald,et al.  The Albumin in Subarachnoid Hemorrhage (ALISAH) Multicenter Pilot Clinical Trial: Safety and Neurologic Outcomes , 2012, Stroke.

[44]  A. Algra,et al.  Interobserver Variability of Grading Scales for Aneurysmal Subarachnoid Hemorrhage , 2011, Stroke.

[45]  A. Lam,et al.  Current Practices of Triple-H Prophylaxis and Therapy in Patients with Subarachnoid Hemorrhage , 2011, Neurocritical care.

[46]  Brian Y. Hwang,et al.  External ventricular drainage following aneurysmal subarachnoid haemorrhage , 2010, British journal of neurosurgery.

[47]  Marek Czosnyka,et al.  Continuous Assessment of Cerebral Autoregulation With Near-Infrared Spectroscopy in Adults After Subarachnoid Hemorrhage , 2010, Stroke.

[48]  S. Cortnum,et al.  Determining the sensitivity of computed tomography scanning in early detection of subarachnoid hemorrhage. , 2010 .

[49]  R. Agid,et al.  Negative CT Angiography Findings in Patients with Spontaneous Subarachnoid Hemorrhage: When Is Digital Subtraction Angiography Still Needed? , 2010, American Journal of Neuroradiology.

[50]  A. Hutson,et al.  Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? , 2010, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[51]  Ale Algra,et al.  Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis , 2009, The Lancet Neurology.

[52]  R. Delgado-Mederos,et al.  ANGIOGRAPHIC AND HEMODYNAMIC EFFECT OF HIGH CONCENTRATION OF INTRA‐ARTERIAL NICARDIPINE IN CEREBRAL VASOSPASM , 2008, Neurosurgery.

[53]  K. Kiening,et al.  The use of hyperventilation therapy after traumatic brain injury in Europe: an analysis of the BrainIT database , 2008, Intensive Care Medicine.

[54]  R. Murali,et al.  High-dose intraarterial verapamil in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage. , 2008, Journal of neurosurgery.

[55]  Robyn Norton,et al.  Saline or albumin for fluid resuscitation in patients with traumatic brain injury. , 2007, The New England journal of medicine.

[56]  J. Gorchynski,et al.  Interpretation of Traumatic Lumbar Punctures in the Setting of Possible Subarachnoid Hemorrhage: Who Can Be Safely Discharged? , 2007, The California journal of emergency medicine.

[57]  C. Robertson,et al.  Management of intracranial hypertension. , 2006, Critical care clinics.

[58]  L. Behan,et al.  The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage , 2005, Clinical endocrinology.

[59]  S. Mayer,et al.  Phenytoin Exposure Is Associated With Functional and Cognitive Disability After Subarachnoid Hemorrhage , 2005, Stroke.

[60]  S. Mayer,et al.  Initial misdiagnosis and outcome after subarachnoid hemorrhage. , 2004, JAMA.

[61]  R. Spetzler,et al.  Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial. , 2004, Journal of neurosurgery.

[62]  K. Waterloo,et al.  Prophylactic Hyperdynamic Postoperative Fluid Therapy after Aneurysmal Subarachnoid Hemorrhage: A Clinical, Prospective, Randomized, Controlled Study , 2001, Neurosurgery.

[63]  S. Mayer,et al.  , Hemorrhage : A Randomized Controlled Trial Effect of Hypervolemic Therapy on Cerebral Blood Flow After Subarachnoid , 2000 .

[64]  J. Martí-Vilalta,et al.  Predictive clinical factors of very early in-hospital mortality in subarachnoid hemorrhage , 1999, Clinical Neurology and Neurosurgery.

[65]  C. Ogilvy,et al.  A proposed comprehensive grading system to predict outcome for surgical management of intracranial aneurysms. , 1998, Neurosurgery.

[66]  V. Feigin,et al.  Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage , 1998, Neurology.

[67]  D. Hannequin,et al.  Causes of morbidity and mortality after ruptured aneurysm surgery in a series of 230 patients. The importance of control angiography. , 1995, Stroke.

[68]  B. Tranmer,et al.  Haemodynamic considerations in the management of patients with subarachnoid haemorrhage , 1991, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[69]  H. Adams,et al.  The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. , 1990, Journal of neurosurgery.

[70]  H. Winn,et al.  Angioplasty for the treatment of symptomatic vasospasm following subarachnoid hemorrhage. , 1989, Journal of neurosurgery.

[71]  E. Macdonald,et al.  Aneurysmal Subarachnoid Hemorrhage , 1989, The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses.

[72]  C. R. Ingram,et al.  Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage. , 1983, The New England journal of medicine.

[73]  C. Symonds,et al.  Spontaneous Sub-Arachnoid Hæmorrhage , 1924, Proceedings of the Royal Society of Medicine.

[74]  J. Ghajar,et al.  In Reply: Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. , 2020, Neurosurgery.

[75]  J. Friedman,et al.  “Triple-H” therapy for cerebral vasospasm following subarachnoid hemorrhage , 2006, Neurocritical care.

[76]  S. Johnston,et al.  Effect of endovascular services and hospital volume on cerebral aneurysm treatment outcomes. , 2000, Stroke.

[77]  J. Ohman,et al.  Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. , 1989, Journal of neurosurgery.

[78]  W. Hunt,et al.  Surgical risk as related to time of intervention in the repair of intracranial aneurysms. , 1968, Journal of neurosurgery.