Medical complications of aneurysmal subarachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study

N. J. Solenski, E. C. Haley, N. F. Kassell, G. Kongable, T. Germanson, L. Truskowski, J. C. Torner, R. F. Spetzler, W. R. Selman, B. Warf, G. H. Barnett, R. A. Solomon, A. H. Friedman, R. L. Campbell, T. Horner, H. J. Nauta, Roberto Heros, J. P. Muizelaar, G. Mohr

Research output: Contribution to journalArticle

428 Citations (Scopus)

Abstract

Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.

Original languageEnglish
Pages (from-to)1007-1017
Number of pages11
JournalCritical Care Medicine
Volume23
Issue number6
DOIs
StatePublished - Jun 26 1995
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Aneurysm
Pulmonary Edema
Cardiac Arrhythmias
Mortality
Liver
Critical Care
Rupture
Length of Stay
Cardiac Edema
Placebos
Kidney
Nicardipine
Ruptured Aneurysm
Intracranial Aneurysm
Thrombocytopenia
Canada
Cause of Death
Sepsis
Extremities

Keywords

  • arrhythmia
  • cerebral aneurysm
  • cerebral ischemia, transient
  • critical care
  • kidney disease
  • liver disease
  • pulmonary edema
  • subarachnoid hemorrhage
  • thrombocytopenia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Solenski, N. J., Haley, E. C., Kassell, N. F., Kongable, G., Germanson, T., Truskowski, L., ... Mohr, G. (1995). Medical complications of aneurysmal subarachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study. Critical Care Medicine, 23(6), 1007-1017. https://doi.org/10.1097/00003246-199506000-00004

Medical complications of aneurysmal subarachnoid hemorrhage : A report of the multicenter, cooperative aneurysm study. / Solenski, N. J.; Haley, E. C.; Kassell, N. F.; Kongable, G.; Germanson, T.; Truskowski, L.; Torner, J. C.; Spetzler, R. F.; Selman, W. R.; Warf, B.; Barnett, G. H.; Solomon, R. A.; Friedman, A. H.; Campbell, R. L.; Horner, T.; Nauta, H. J.; Heros, Roberto; Muizelaar, J. P.; Mohr, G.

In: Critical Care Medicine, Vol. 23, No. 6, 26.06.1995, p. 1007-1017.

Research output: Contribution to journalArticle

Solenski, NJ, Haley, EC, Kassell, NF, Kongable, G, Germanson, T, Truskowski, L, Torner, JC, Spetzler, RF, Selman, WR, Warf, B, Barnett, GH, Solomon, RA, Friedman, AH, Campbell, RL, Horner, T, Nauta, HJ, Heros, R, Muizelaar, JP & Mohr, G 1995, 'Medical complications of aneurysmal subarachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study', Critical Care Medicine, vol. 23, no. 6, pp. 1007-1017. https://doi.org/10.1097/00003246-199506000-00004
Solenski, N. J. ; Haley, E. C. ; Kassell, N. F. ; Kongable, G. ; Germanson, T. ; Truskowski, L. ; Torner, J. C. ; Spetzler, R. F. ; Selman, W. R. ; Warf, B. ; Barnett, G. H. ; Solomon, R. A. ; Friedman, A. H. ; Campbell, R. L. ; Horner, T. ; Nauta, H. J. ; Heros, Roberto ; Muizelaar, J. P. ; Mohr, G. / Medical complications of aneurysmal subarachnoid hemorrhage : A report of the multicenter, cooperative aneurysm study. In: Critical Care Medicine. 1995 ; Vol. 23, No. 6. pp. 1007-1017.
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title = "Medical complications of aneurysmal subarachnoid hemorrhage: A report of the multicenter, cooperative aneurysm study",
abstract = "Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46{\%}, 7{\%}, and 19{\%}, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40{\%}. The proportion of deaths from medical complications was 23{\%}. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19{\%}), rebleeding (22{\%}), and vasospasm (23{\%}) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5{\%}; less ominous rhythm disturbances occurred in 30{\%} of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23{\%} of the patients, with a 6{\%} occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24{\%} of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4{\%} frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4{\%} of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7{\%} of the patients, with 15{\%} of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.",
keywords = "arrhythmia, cerebral aneurysm, cerebral ischemia, transient, critical care, kidney disease, liver disease, pulmonary edema, subarachnoid hemorrhage, thrombocytopenia",
author = "Solenski, {N. J.} and Haley, {E. C.} and Kassell, {N. F.} and G. Kongable and T. Germanson and L. Truskowski and Torner, {J. C.} and Spetzler, {R. F.} and Selman, {W. R.} and B. Warf and Barnett, {G. H.} and Solomon, {R. A.} and Friedman, {A. H.} and Campbell, {R. L.} and T. Horner and Nauta, {H. J.} and Roberto Heros and Muizelaar, {J. P.} and G. Mohr",
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TY - JOUR

T1 - Medical complications of aneurysmal subarachnoid hemorrhage

T2 - A report of the multicenter, cooperative aneurysm study

AU - Solenski, N. J.

AU - Haley, E. C.

AU - Kassell, N. F.

AU - Kongable, G.

AU - Germanson, T.

AU - Truskowski, L.

AU - Torner, J. C.

AU - Spetzler, R. F.

AU - Selman, W. R.

AU - Warf, B.

AU - Barnett, G. H.

AU - Solomon, R. A.

AU - Friedman, A. H.

AU - Campbell, R. L.

AU - Horner, T.

AU - Nauta, H. J.

AU - Heros, Roberto

AU - Muizelaar, J. P.

AU - Mohr, G.

PY - 1995/6/26

Y1 - 1995/6/26

N2 - Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.

AB - Objectives: This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subarachnoid hemorrhage are evaluated. Design: A study of medical complications observed in the placebo limb of a large, randomized, controlled trial of the calcium antagonist, nicardipine, after subarachnoid hemorrhage. Setting: Patients were recruited from 50 hospitals in 41 neurosurgical centers in the United States and Canada. Patients: A total of 457 patients with subarachnoid hemorrhage, ≥18 yrs of age, were randomly assigned to the placebo group. All patients arrived at the participating center within 7 days (mean 1.0 ± 1.8 [SD] days) of rupture of an angiographically documented saccular aneurysm. Measurements and Main Results: The frequency rates of symptomatic vasospasm, rebleeding, and total mortality rate after subarachnoid hemorrhage at 3-month follow-up were 46%, 7%, and 19%, respectively. The frequency of having at least one severe (life- threatening) medical complication was 40%. The proportion of deaths from medical complications was 23%. This value was comparable with the proportion of deaths attributed to the direct effects of the initial hemorrhage (19%), rebleeding (22%), and vasospasm (23%) after aneurysmal rupture. The frequency of life-threatening cardiac arrhythmias was 5%; less ominous rhythm disturbances occurred in 30% of the patients. There was an increased frequency of cardiac arrhythmias on the day of, or day after, aneurysm surgery. Pulmonary edema occurred in 23% of the patients, with a 6% occurrence rate incidence of severe pulmonary edema. There was a wide variation from center to center, with the greatest frequency on days 3 through 7. There was a nonsignificant association of pulmonary edema with the use of hypertensive hypervolemic therapy (p = .10), and a significant association with the timing of surgery (p < .05). Some degree of hepatic dysfunction was noted in 24% of patients, the majority with only mild abnormalities of hepatic enzymes with no clinical accompaniment (4% frequency of severe hepatic dysfunction). Thrombocytopenia occurred in 4% of patients, usually in the setting of sepsis. Renal dysfunction was reported in 7% of the patients, with 15% of that figure deemed to be of life-threatening severity. There was an association (p = .001) with antibiotic therapy. Conclusions: Potentially preventable medical complications after ruptured cerebral aneurysm add to the total mortality rate of patients, and may increase length of hospital stay in the critical care setting. The proportion of deaths after subarachnoid hemorrhage from medical complications equals those deaths from either direct effects, rebleeding, or vasospasm individually. Pulmonary complications are the most common nonneurologic cause of death. Cardiac arrhythmia, although frequent, was not associated with significant mortality. The frequency of cardiac arrhythmia and pulmonary edema increased on the day of, or day after, aneurysm surgery. Renal and hepatic dysfunction, and blood dyscrasias, were also observed, underscoring the need for meticulous monitoring for metabolic and hematologic derangements.

KW - arrhythmia

KW - cerebral aneurysm

KW - cerebral ischemia, transient

KW - critical care

KW - kidney disease

KW - liver disease

KW - pulmonary edema

KW - subarachnoid hemorrhage

KW - thrombocytopenia

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