Key result
Recent advances in aSAH management highlight CT perfusion for DCI diagnosis, favor hemodynamic augmentation over triple H therapy, and show no benefit for simvastatin or intravenous magnesium.
This review highlights that hemodynamic augmentation alone is now the mainstay of medical management for aSAH, while hypervolemia, simvastatin, and IV magnesium are not beneficial for preventing delayed cerebral ischemia.
Supports hemodynamic augmentation for aSAH-related DCI; leaves open prospective validation of CT perfusion and preventive alternatives.
PURPOSE OF REVIEW: Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects. RECENT FINDINGS: Growing body of evidence highlights the usefulness of CT perfusion scans in the diagnosis of vasospasm and delayed cerebral ischemia (DCI). Hypervolemia leads to worse cardiopulmonary outcomes and does not improve DCI. The traditional triple H therapy is falling out of favor with hemodynamic augmentation alone now considered the mainstay of medical management. Randomized controlled trials have shown that simvastatin and intravenous magnesium do not prevent DCI or improve functional outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Emerging data using multimodality monitoring has further advanced our understanding of the pathophysiology of DCI in poor grade aSAH. SUMMARY: The brief review will focus on the postinterventional care of aSAH patients outlining the recent advances over the past few years.
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Datar et al. (2017) conducted a review in Aneurysmal subarachnoid hemorrhage (aSAH). Postinterventional critical care management was evaluated. Recent advances in aSAH management highlight CT perfusion for DCI diagnosis, favor hemodynamic augmentation over triple H therapy, and show no benefit for simvastatin or intravenous magnesium.
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