Transoceanic Management and Treatment of Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-Because of the small number of yearly cases of ruptured cerebral aneurysms, endovascular treatment is not performed in Martinique. Therefore, patients from Martinique are sent 7000 km to Paris on commercial flights as soon as possible, where treatment is performed. Nontransportable patients are treated locally with either surgery or symptomatic care. The objective of our study was to assess patient outcomes and safety of this treatment strategy. Methods-We retrospectively examined all cases of aneurysmal subarachnoid hemorrhage in Martinique diagnosed during 2004 to 2013. Medical case records were searched for the type and location of treatment, clinical status, and transfer duration. Results-A total of 119 patients had an aneurysmal subarachnoid hemorrhage during the 10-year period. Of these, 91were transferred to Paris, 12 were surgically treated locally, and 16 received symptomatic treatment. None of the transferred patients experienced any hemorrhagic recurrence, and none suffered a significant complication related to the air transportation. The median time between aneurysmal subarachnoid hemorrhage diagnosis and arrival at the referral center was 32 hours. The 30-day case fatality rate for treated cases was 14.6% (8.8% for those treated in Paris and 58.3% for those treated locally). Conclusions-Our treatment strategy for aneurysmal subarachnoid hemorrhage resulted in a 30-day case fatality rate similar to those observed elsewhere, despite an 8-hour flight and a median treatment delay of 32 hours. This strategy therefore seems to be safe and reliable for isolated regions with small populations.

Prognosis of aneurysmal subarachnoid hemorrhage not altered with transatlantic airplane transfer. A bicentric matched case–control study

“…Mejdoubi et al studied a population of 119 aHSA patients from Martinique (another Caribbean island very close to Guadeloupe) over 10 years, 91 of whom were air-transferred to mainland France (also to the RFH), with the alternative of surgical treatment of the aneurysm in Martinique or conservative treatment for patients with the most severe disease. 13 The proportion of patients with mRS score ≤ 3 and mortality at hospital discharge was 80% and 9%, respectively, for patients transferred to metropolitan France as compared with 75% and 18% at 1 year in our series. This difference might be explained by the timing of the result measurement and by patients with the most severe disease being not transferred to mainland France.…”

One-year survival of aneurysmal subarachnoid hemorrhage after airplane transatlantic transfer – a monocenter retrospective study

“…The transfer is an eighthour flight and there are two to five commercial flights a day. Similar arrangements have been adopted in Martinique, another French West Indies Island [11]. In addition to international guidelines, to optimize patient's safety during the flight, our department has developed local guidelines to manage patients prior to the flight.…”

Apelin-13 attenuates early brain injury through inhibiting inflammation and apoptosis in rats after experimental subarachnoid hemorrhage

“…Following SAH, previous literature has reported the occurrence of early brain injury (EBI) and cognitive de cits. EBI has been regarded as the major contributor to the neurological dysfunction and poor clinical outcomes in patients following SAH [4,5].…”