Article
Mitigation of cisternal and ventricular blood load as risk factors for poor outcome after subarachnoid haemorrhage by implementation of cisternal lavage
Zisternale und ventrikuläre Blutmenge verlieren ihre Bedeutung als Risikofaktoren für schlechtes Outcome nach Subarachnoidalblutung durch Einführung von Zisternenlavage-Verfahren
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Published: | June 4, 2021 |
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Objective: The initial amount of subarachnoid and ventricular blood is an important predictor for outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). In this comparative study of an unselected aSAH-population we assess the modifiability of these risk factors by implementation of blood clearance by cisternal lavage.
Methods: All patients with aneurysmal subarachnoid hemorrhage (aSAH) treated in our department between 10/2011 and 10/2019 (8 years, n=458) were included in our study. In the first 4-year period (BEFORE), patients with aSAH were treated according to international guidelines. In the second 4-year period (AFTER), cisternal lavage methods were available (n=221) and applied in 72 high-risk patients (31%). The initial cisternal and ventricular blood load was recorded by the Hijdra score. Multivariable regression models were used to assess the prognostic significance of risk factors, including blood load, in relation to common aSAH characteristics in both study groups.
Results: Worse neurological outcomes occurred in the BEFORE population with 41.45 % (BEFORE) vs. 30.77 % (AFTER) unfavorable outcome (mRS >3) six months after aSAH, HR: 1.59 (95% CI 1.08 - 2.34, p=0.01). Admission WFNS grade, comorbidities (CCI), herniation signs, concomitant intracerebral hemorrhage, and the development of delayed cerebral infarction were strongly associated with poor outcome in both study groups. Intraventricular and cisternal blood load and, particularly, a cast fourth ventricle represented strong prognosticators of poor neurological outcome in the BEFORE cohort. This effect was lost after implementation of cisternal lavage (AFTER cohort).
Conclusion: Cisternal and ventricular blood load - in particular: a cast fourth ventricle - represent important prognosticators in patients with aSAH. They are, however, amenable to modification by blood clearing therapies.
Figure 1 [Fig. 1]