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Impact of Goal-Directed Therapy on Delayed Ischemia After Aneurysmal Subarachnoid Hemorrhage: Randomized Controlled
Aida Anetsberger1, Jens Gempt2, Manfred Blobner1
1Department of Anesthesiology (A.A., M.B., R.B., M.H., G.S., S.S., J.S., J.M., M.E., B.J.), Klinikum rechts der Isar, Technical University Munich, Germany.
Insights
Goal-directed hemodynamic therapy (GDHT) significantly reduced delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. This improved patient functional outcomes, showing GDHT as a superior treatment strategy.
Area of Science:
- Neurology
- Critical Care Medicine
- Neurosurgery
Background:
- Delayed cerebral ischemia (DCI) is a major cause of poor outcomes following subarachnoid hemorrhage (SAH).
- Effective strategies to prevent DCI are crucial for improving patient prognosis after SAH.
Purpose of the Study:
- To evaluate the efficacy of goal-directed hemodynamic therapy (GDHT) compared to standard care in reducing DCI rates.
- To assess the impact of GDHT on functional outcomes in patients with SAH.
Main Methods:
- A prospective randomized controlled trial was conducted with adult patients diagnosed with aneurysmal SAH.
- Patients were randomized to either standard care or GDHT, which involved advanced hemodynamic monitoring and specific treatment algorithms.
- The primary endpoint was the incidence of DCI, with functional outcomes assessed using the Glasgow Outcome Scale (GOS) at 3 months post-discharge.
Main Results:
- GDHT significantly reduced the occurrence of DCI compared to standard care (13% vs. 32%, P=0.021).
- Patients receiving GDHT demonstrated better functional outcomes at 3 months, with a higher proportion achieving GOS 5 (minor or no deficits) (66% vs. 44%, P=0.025).
- No significant difference in mortality was observed between the GDHT and standard care groups.
Conclusions:
- GDHT is effective in reducing DCI rates following subarachnoid hemorrhage.
- GDHT leads to improved functional outcomes for patients recovering from SAH.
- The study supports the use of GDHT as a beneficial therapeutic approach in managing SAH patients.
Background And Purpose:
Delayed cerebral ischemia (DCI) is the most important cause for a poor clinical outcome after a subarachnoid hemorrhage. The aim of this study was to assess whether goal-directed hemodynamic therapy (GDHT), as compared to standard clinical care, reduces the rate of DCI after subarachnoid hemorrhage.
Methods:
We conducted a prospective randomized controlled trial. Patients >18 years of age with an aneurysmal subarachnoid hemorrhage were enrolled and randomly assigned to standard therapy or GDHT. Advanced hemodynamic monitoring and predefined GDHT algorithms were applied in the GDHT group. The primary end point was the occurrence of DCI. Functional outcome was assessed using the Glasgow Outcome Scale (GOS) 3 months after discharge.
Results:
In total, 108 patients were randomized to the control (n=54) or GDHT group (n=54). The primary outcome (DCI) occurred in 13% of the GDHT group and in 32% of the control group patients (odds ratio, 0.324 [95% CI, 0.11-0.86]; P=0.021). Even after adjustment for confounding parameters, GDHT was found to be superior to standard therapy (hazard ratio, 2.84 [95% CI, 1.18-6.86]; P=0.02). The GOS was assessed 3 months after discharge in 107 patients; it showed more patients with a low disability (GOS 5, minor or no deficits) than patients with higher deficits (GOS 1-4) in the GDHT group compared with the control group (GOS 5, 66% versus 44%; GOS 1-4, 34% versus 56%; P=0.025). There was no significant difference in mortality between the groups.
Conclusions:
GDHT reduced the rate of DCI after subarachnoid hemorrhage with a better functional outcome (GOS=5) 3 months after discharge. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01832389.
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