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

Publication Title

Journal of neurosurgical anesthesiology

Authors

Edoardo Picetti
Pierre Bouzat
Mary Kay Bader, Mission Neuroscience Institute/Critical Care Services, Providence Mission Hospital, Mission Viejo CA, USAFollow
Giuseppe Citerio
Raimund Helbok
Janneke Horn
Robert Loch Macdonald
Victoria McCredie
Geert Meyfroidt
Cássia Righy
Chiara Robba
Deepak Sharma
Wade S Smith
Jose I Suarez
Andrew Udy
Stefan Wolf
Fabio S Taccone

Document Type

Article

Publication Date

5-26-2023

Keywords

california; mission viejo

Abstract

INTRODUCTION: Cerebral infarction from delayed cerebral ischemia (DCI) is a leading cause of poor neurological outcome after aneurysmal subarachnoid hemorrhage (aSAH). We performed an international clinical practice survey to identify monitoring and management strategies for cerebral vasospasm associated with DCI in aSAH patients requiring intensive care unit admission.

METHODS: The survey questionnaire was available on the European Society of Intensive Care Medicine (May 2021-June 2022) and Neurocritical Care Society (April - June 2022) websites following endorsement by these societies.

RESULTS: There were 292 respondents from 240 centers in 38 countries. In conscious aSAH patients or those able to tolerate an interruption of sedation, neurological examination was the most frequently used diagnostic modality to detect delayed neurological deficits related to DCI caused by cerebral vasospasm (278 respondents, 95.2%), while in unconscious patients transcranial Doppler/cerebral ultrasound was most frequently used modality (200, 68.5%). Computed tomography angiography was mostly used to confirm the presence of vasospasm as a cause of DCI. Nimodipine was administered for DCI prophylaxis by the majority of the respondents (257, 88%), mostly by an enteral route (206, 71.3%). If there was a significant reduction in arterial blood pressure after nimodipine administration, a vasopressor was added and nimodipine dosage unchanged (131, 45.6%) or reduced (122, 42.5%). Induced hypertension was used by 244 (85%) respondents as first-line management of DCI related to vasospasm; 168 (59.6%) respondents used an intra-arterial procedure as second-line therapy.

CONCLUSIONS: This survey demonstrated variability in monitoring and management strategies for DCI related to vasospasm after aSAH. These findings may be helpful in promoting educational programs and future research.

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

DOI

10.1097/ANA.0000000000000923