Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

Anniina H Autio,Mikael Von Und Zu Fraunberg,Antti E Lindgren,Joona Tervonen,Virve Kärkkäinen,Jukka Huttunen,Maarit Lång,Olli-Pekka Kämäräinen,Juho Paavola,Terhi J Huuskonen,Juha E Jääskeläinen,Timo Koivisto

doi:10.1007/s00701-021-04725-2

Anniina H Autio, Mikael Von Und Zu Fraunberg + Show 10 more

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https://doi.org/10.1007/s00701-021-04725-2

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Abstract

BackgroundTo study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care.MethodsOf the 769 consecutive aSAH patients from a defined population (2005–2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years.ResultsThe 120 H&H 4–5 patients alive at 3 years form the final study population. On admission, 73% had H&H 4 but only 27% H&H 5, 59% intracerebral hematoma (ICH; median 22 cm3), and 26% intraventricular blood clot (IVH). The outcome was favorable (mRS 0–1) in 45% (54 patients: ICH 44%; IVH clot 31%; shunt 46%), moderate (mRS 2–3) in 30% (36 patients: ICH 64%; IVH clot 19%; shunt 42%), and unfavorable (mRS 4–5) in 25% (30 patients: ICH 80%; IVH clot 23%; shunt 50%). A total of 46% carried a ventriculoperitoneal shunt. ICH volume was a significant predictor of mRS at 3 years.ConclusionsOf poor-grade aSAH patients, 45% were alive at 3 years, even 27% of those extending to pain (H&H 5). Of the survivors, 75% were at least in moderate condition, while only 2.6% ended in hospice care. Consequently, we propose non-selected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates.

Highlights

Methods and materialsAneurysmal subarachnoid hemorrhage, in most cases from a ruptured saccular intracranial aneurysm, is the third most frequent form of stroke [26, 50]
In Finland, with national presumed consent since 2010 [21, 45], aneurysmal subarachnoid hemorrhage (aSAH) patients with dismal prognosis can be admitted to neurointensive care as potential organ donors, at high age
A total of 269 consecutive aSAH patients were in poor condition (H&H 4, n=145; Hunt and Hess (H&H) 5, n=124) on admission to the Kuopio University Hospital (KUH) Neurointensive Care Unit

Summary

Introduction

Methods and materialsAneurysmal subarachnoid hemorrhage (aSAH), in most cases from a ruptured saccular intracranial aneurysm (sIA), is the third most frequent form of stroke [26, 50]. Poor condition predicts high early mortality, and aSAH patients brain dead within 14 days are a significant group of organ donors [21]. A minority of H&H 4–5 or WFNS 4–5 patients will become true long-term survivors, alive e.g., at 5 years or 10 years, albeit being stroke-risk carriers and prone to further vascular events [16]. To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care. Methods Of the 769 consecutive aSAH patients from a defined population (2005–2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5 Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. We propose nonselected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates

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