Therapeutic Strategies for Poor-grade Subarachnoid Hemorrhage Patients and Clinical Outcomes

Abstract

Patients with poor-grade subarachnoid hemorrhage have a very poor prognosis, especially those with cardiopulmonary arrest and/or bilateral dilated pupils. Therapeutic indications for patients with poor-grade subarachnoid hemorrhage vary depending on the institution; however, we perform clipping or coil embolization in these patients with very poor-grade subarachnoid hemorrhage if their vital signs are stable at the time of admission. In this study, we summarize the outcomes of 31 patients with poor-grade subarachnoid hemorrhage seen between January 2015 and April 2017. Among the 31 patients, 13 patients had cardiopulmonary arrest at the time of admission and/or prehospital, and 15 patients had bilateral dilated pupils. Among these 13 patients with cardiopulmonary arrest, seven patients underwent clipping or coil embolization because their vital signs could be stabilized. The functional outcomes of these seven patients were very poor: mRS 1 (1 patient), mRS 4 (1 patient), and mRS 5 (5 patients); however, all of these patients survived 30 days after the subarachnoid hemorrhage onset. Meanwhile, the other nine patients with unstable vital signs and who could therefore not undergo clipping or coil embolization died within 30 days after the subarachnoid hemorrhage onset.In conclusion, although the functional outcomes of patients with poor grade subarachnoid hemorrhage and cardiopulmonary arrest were very poor, a minority of these patients had good functional outcomes.

Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage with World Federation of Neurological Societies grade V(OPAS-V)

“…Maximal treatment for all patients with WFNS grade V aSAH is challenging and controversial due to high mortality rates and poor prognoses. 10,13 Conversely, several reports have revealed that some of patients have good outcomes. 9,[11][12][13][14] It is still unclear which factors develops this heterogeneity in their outcomes.…”

“…10,13 Conversely, several reports have revealed that some of patients have good outcomes. 9,[11][12][13][14] It is still unclear which factors develops this heterogeneity in their outcomes. However, our decision tree model, OPAS-V, based on the routine examinations including laboratory findings at admission may be useful in identifying patients who need aggressive treatment.…”

“…10,11 Conversely, several reports have revealed that 14-25% of aggressively treated patients with WFNS grade V aSAH had good outcomes. 9,[11][12][13][14] The clinical severity of aSAH at admission has been reported to reflect the acute inflammatory response, including early brain injury (EBI). [15][16][17] In patients with WFNS grade V, the impact of EBI on their outcomes may be heterogeneous 16,18 and should be considered when developing outcome prediction models.…”