[Is hyperdynamic therapy possible for elderly patients with vasospasm following subarachnoid hemorrhage?]

Recently we have an increased number of elderly patients with subarachnoid hemorrhage (SAH) to be treated. Elderly patients are expected to have a worse cardiac function than that of younger patients. A question arises whether management for elderly patients in the vasospasm period can be performed as safely as it is for younger patients. The aim of this study is to examine the cardiac function of the elderly patients (> or =75 y.o.) with SAH correlated with various complications in the vasospasm period.

We retrospectively analyzed consecutive 356 patients with SAH encountered in our institute since 2000 to 2006. Seventy-three patients (20.5% of all) are 75 or more than 75-year-old. Their mean age is 80.4 +/- 4.43 (16 male, 57 female). Cardiac function was examined by trans-thoracic echocardiography (CTE) in 40 patients (54.8%).

Average value of their ejection fraction (EF) and rates of perioperative complications were not so different from those of the younger patients. But among patients of > or =75 y.o., certain patients in whom EF was under 0.6 significantly have experienced cardiopulmonary complications and longer hospitalization. In a multiple logistic analyses, only EF is significantly related with cardiopulmonary complications (P = 0.013).

Among elderly SAH patients > or =75 year of age, some have experienced more cardiopulmonary complications than younger patients and have needed longer hospitalization. For such patients hyperdynamic therapy must be carefully carried out. TTE is effective to predispose and help eliminate their cardiopulmonary complications in the pre- and postoperative period.