Anniina H Autio1,2, Juho Paavola3,4, Joona Tervonen3,4, Maarit Lång5,4, Terhi J Huuskonen3,4, Jukka Huttunen3,4, Virve Kärkkäinen3, Mikael von Und Zu Fraunberg3,4, Antti E Lindgren3,6,4, Timo Koivisto3,4, Juha E Jääskeläinen3,4, Olli-Pekka Kämäräinen3,4. 1. Neurosurgery of NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland. anniaut@uef.fi. 2. Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. anniaut@uef.fi. 3. Neurosurgery of NeuroCenter, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland. 4. Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. 5. Neurointensive Care Unit, Kuopio University Hospital, Kuopio, Finland. 6. Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
Abstract
BACKGROUND: 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. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years. RESULTS: The 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. CONCLUSIONS: Of 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.
BACKGROUND: 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. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years. RESULTS: The 120 H&H 4-5patients 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. CONCLUSIONS: Of 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.
Authors: Hadie Adams; Vin Shen Ban; Ville Leinonen; Salah G Aoun; Jukka Huttunen; Taavi Saavalainen; Antti Lindgren; Juhana Frosen; Mikael Fraunberg; Timo Koivisto; Juha Hernesniemi; Babu G Welch; Juha E Jaaskelainen; Terhi J Huttunen Journal: Stroke Date: 2016-09-15 Impact factor: 7.914
Authors: Issam A Awad; Sean P Polster; Julián Carrión-Penagos; Richard E Thompson; Ying Cao; Agnieszka Stadnik; Patricia Lynn Money; Maged D Fam; Janne Koskimäki; Romuald Girard; Karen Lane; Nichol McBee; Wendy Ziai; Yi Hao; Robert Dodd; Andrew P Carlson; Paul J Camarata; Jean-Louis Caron; Mark R Harrigan; Barbara A Gregson; A David Mendelow; Mario Zuccarello; Daniel F Hanley Journal: Neurosurgery Date: 2019-06-01 Impact factor: 4.654
Authors: Priscila Corraini; Victor W Henderson; Anne G Ording; Lars Pedersen; Erzsébet Horváth-Puhó; Henrik T Sørensen Journal: Stroke Date: 2016-11-29 Impact factor: 7.914
Authors: Jennifer A Frontera; Wamda Ahmed; Victor Zach; Maximo Jovine; Lawrence Tanenbaum; Fatima Sehba; Aman Patel; Joshua B Bederson; Errol Gordon Journal: J Neurol Neurosurg Psychiatry Date: 2014-04-08 Impact factor: 10.154
Authors: Naif M Alotaibi; Ghassan Awad Elkarim; Nardin Samuel; Oliver G S Ayling; Daipayan Guha; Aria Fallah; Abdulrahman Aldakkan; Blessing N R Jaja; Airton Leonardo de Oliveira Manoel; George M Ibrahim; R Loch Macdonald Journal: J Neurosurg Date: 2017-01-06 Impact factor: 5.115
Authors: Rahul Damani; Stephan Mayer; Raj Dhar; Renee H Martin; Paul Nyquist; DaiWai M Olson; Jorge H Mejia-Mantilla; Susanne Muehlschlegel; Edward C Jauch; J Mocco; Tatsushi Mutoh; Jose I Suarez Journal: Neurocrit Care Date: 2019-06 Impact factor: 3.210