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Predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a cardiac focus

Khalil Yousef1, Elizabeth Crago, Chien-Wen Kuo

  • 1School of Nursing, University of Pittsburgh, 365 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA. Kmy12@pitt.edu

Neurocritical Care
|July 21, 2010
PubMed

Insights

Elevated cardiac output and Fisher grade predict delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). However, DCI prediction may not impact overall mortality rates in these patients.

Area of Science:

  • Neurology
  • Cardiology
  • Critical Care Medicine

Background:

  • Myocardial injury and delayed cerebral ischemia (DCI) are serious complications following aneurysmal subarachnoid hemorrhage (aSAH).
  • These conditions are linked to poorer patient outcomes.
  • The relationship between aSAH-associated myocardial injury (SAHMI) and DCI requires further investigation.

Purpose of the Study:

  • To determine if demographics, aSAH severity, aneurysm location, or SAHMI can predict DCI.
  • To assess the association between DCI and mortality after aSAH.

Main Methods:

  • A prospective longitudinal study was conducted on 149 aSAH patients (age 18-75) admitted to the Neurovascular ICU.
  • Patients had definitive DCI evaluation, Hunt and Hess (HH) grade ≥ 3, and/or Fisher grade ≥ 2.
  • DCI was defined by neurological deterioration and evidence of abnormal cerebral blood flow.

Main Results:

  • 48% of subjects developed DCI. DCI(+) patients had more severe aSAH (higher HH and Fisher grades, lower GCS).
  • Pulmonary congestion was more frequent in DCI(+) patients (63% vs. 39%).
  • Elevated cardiac output (CO) and higher Fisher grade independently predicted DCI. Each 1 LPM increase in CO raised DCI odds by 1.5; Fisher grade 4 increased odds by 6.5 compared to grade 2.

Conclusions:

  • Elevated cardiac output and Fisher grade are significant predictors of DCI following aSAH.
  • Despite predicting DCI, these factors may not influence the three-month mortality rate.
  • Further research is needed to explore DCI prevention strategies and their impact on mortality.
Abstract

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