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Multidisciplinary and standardized management of patients with delayed cerebral ischemia after aneurysmal

Amr Abdulazim1, Carla Küppers2, Katharina A M Hackenberg2

  • 1Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. amr.abdulazim@umm.de.

Acta Neurochirurgica
|August 25, 2022
PubMed

Insights

Implementing a standardized protocol for managing delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) significantly reduced cerebral infarction and improved patient outcomes. This multidisciplinary approach enhances DCI management and functional recovery.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Delayed cerebral ischemia (DCI) management after aneurysmal subarachnoid hemorrhage (aSAH) lacks standardized protocols, leading to uncertainty in optimal patient care.
  • Cerebral infarction and poor functional outcomes remain significant challenges for patients with aSAH.

Purpose of the Study:

  • To evaluate the impact of a standardized multidisciplinary protocol for DCI detection and management on cerebral infarction and functional outcomes in aSAH patients.
  • To assess the effectiveness of a structured approach in improving patient recovery after aSAH.

Main Methods:

  • Two cohorts of aSAH patients were compared: pre-implementation (n=143) and post-implementation (n=158) of a standardized DCI protocol.
  • The protocol included standardized neurological/radiological assessments and risk-based medical treatment for DCI.
  • Cerebral infarction and functional outcomes (extended Glasgow Outcome Scale) were assessed at 3 months post-aSAH.

Main Results:

  • The post-implementation cohort showed significantly lower rates of overall cerebral infarction (29.1% vs. 46.9%) and DCI-related infarction (17.7% vs. 31.5%) compared to the pre-implementation cohort.
  • Unfavorable functional outcomes at 3 months were reduced in the post-implementation cohort (37.3% vs. 53.8%).
  • For patients with DCI, unfavorable functional outcomes decreased from 77.8% to 42.3% after protocol implementation.

Conclusions:

  • A multidisciplinary approach incorporating standardized assessments and tailored therapies significantly reduces cerebral infarction and improves functional outcomes in aSAH patients.
  • The implemented protocol demonstrates a substantial benefit in managing DCI and enhancing patient recovery.
  • This standardized strategy is associated with better neurological and functional recovery after aneurysmal subarachnoid hemorrhage.
Abstract

Keywords:
Delayed cerebral ischemiaIntra-arterial treatmentPerfusion CTSubarachnoid hemorrhageVasospasm

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