Journal article
Subarachnoid hemorrhage: who dies, and why?
Critical care (London, England), Vol.19(1), pp.309-309
2015
DOI: 10.1186/s13054-015-1036-0
PMCID: PMC4556224
PMID: 26330064
Abstract
Introduction: Subarachnoid hemorrhage (SAH) is a devastating form of stroke. Causes and mechanisms of in-hospital death after SAH in the modern era of neurocritical care remain incompletely understood.
Methods: We studied 1200 consecutive SAH patients prospectively enrolled in the Columbia University SAH Outcomes Project between July 1996 and January 2009. Analysis was performed to identify predictors of in-hospital mortality.
Results: In-hospital mortality was 18% (216/1200): 3% for Hunt-Hess grade 1 or 2, 9% for grade 3, 24% for grade 4, and 71% for grade 5. The most common adjudicated primary causes of death or neurological devastation leading to withdrawal of support were direct effects of the primary hemorrhage (55%), aneurysm rebleeding (17%), and medical complications (15%). Among those who died, brain death was declared in 42%, 50% were do-not-resuscitate at the time of cardiac death (86% of whom had life support actively withdrawn), and 8% died despite full support. Admission predictors of mortality were age, loss of consciousness at ictus, admission Glasgow Coma Scale score, large aneurysm size, Acute Physiology and Chronic Health Evaluation II (APACHE II) physiologic subscore, and Modified Fisher Scale score. Hospital complications that further increased the risk of dying in multivariable analysis included rebleeding, global cerebral edema, hypernatremia, clinical signs of brain stem herniation, hypotension of less than 90 mm Hg treated with pressors, pulmonary edema, myocardial ischemia, and hepatic failure. Delayed cerebral ischemia, defined as deterioration or infarction from vasospasm, did not predict mortality.
Conclusion: Strategies directed toward minimizing early brain injury and aneurysm rebleeding, along with prevention and treatment of medical complication, hold the best promise for further reducing mortality after SAH.
Details
- Title: Subtitle
- Subarachnoid hemorrhage: who dies, and why?
- Creators
- Hector Lantigua - Department of Neurology, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave, New York, NY 10032 USASantiago Ortega-Gutierrez - Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USAJ. Michael Schmidt - Department of Neurology, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave, New York, NY 10032 USAKiwon Lee - The University of Texas at Houston, 6431 Fannin St., Houston, TX 77030 USANeeraj Badjatia - The University of Maryland, 22 South Greene St., Baltimore, MD 21201 USASachin Agarwal - Department of Neurology, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave, New York, NY 10032 USAJan Claassen - Department of Neurology, Columbia University College of Physicians and Surgeons, 177 Fort Washington Ave, New York, NY 10032 USAE. Sander Connolly - Department of Neurosurgery, Columbia University College of Physicians and Surgeons, 710 West 168th St., New York, NY 10032 USAStephan A Mayer - Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1522, New York, NY 10029-6574 USA
- Resource Type
- Journal article
- Publication Details
- Critical care (London, England), Vol.19(1), pp.309-309
- DOI
- 10.1186/s13054-015-1036-0
- PMID
- 26330064
- PMCID
- PMC4556224
- NLM abbreviation
- Crit Care
- ISSN
- 1364-8535
- eISSN
- 1466-609X
- Publisher
- BioMed Central; London
- Grant note
- DOI: 10.13039/100000002, name: National Institutes of Health, award: P50 NS049060, UL1 TR000040; DOI: 10.13039/100000968, name: American Heart Association, award: 9750432N
- Language
- English
- Date published
- 2015
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020654002771
Metrics
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