How do I manage cerebral vasospasm and delayed cerebral ischemia?

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Delayed cerebral ischemia (DCI) is a primary cause of mortality and disability after subarachnoid hemorrhage (SAH).
• Current management guidelines for DCI are primarily based on expert opinion due to limited randomized controlled trials (RCTs).

Purpose of the Study:

• To review existing literature on DCI following SAH.
• To describe local protocols for DCI prophylaxis, risk stratification, monitoring, and intervention.
• To highlight the need for evolving protocols based on emerging clinical trial evidence.

Main Methods:

• Literature review of available studies on DCI.
• Description of institutional protocols for managing patients at risk of DCI.
• Discussion of multimodal invasive monitoring techniques.
• Outline of intervention strategies for established DCI.

Main Results:

• Protocols align with current expert-based guidelines.
• Multimodal monitoring and specific interventions are key components of care.
• Evidence base for interventions is evolving and requires further research.

Conclusions:

• Established protocols provide a framework for DCI management.
• Continuous evaluation and adaptation of protocols are necessary as new evidence emerges from ongoing and future trials.
• Improved evidence from RCTs will refine DCI treatment strategies.