Eagles Matthew E, MacLean Mark A, Kameda-Smith Michelle M, Duda Taylor, Persad Amit R L, Almojuela Alysa, Bokhari Rakan, Iorio-Morin Christian, Elkaim Lior M, Rizzuto Michael A, Lownie Stephen P, Christie Sean D, Teitelbaum Jeanne
Department of Neurosurgery, University of Calgary, Calgary, Alberta, Canada.
Dalhousie University, 3rd Floor, Halifax Infirmary, Division of Neurosurgery, Department of Surgery, Halifax, Nova Scotia, Canada.
Can J Neurol Sci. 2023 May;50(3):380-388. doi: 10.1017/cjn.2022.44. Epub 2022 Apr 28.
Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (aSAH) and is associated with significant morbidity and mortality. There is little high-quality evidence available to guide the management of DCI. The Canadian Neurosurgery Research Collaborative (CNRC) is comprised of resident physicians who are positioned to capture national, multi-site data. The objective of this study was to evaluate practice patterns of Canadian physicians regarding the management of aSAH and DCI.
We performed a cross-sectional survey of Canadian neurosurgeons, intensivists, and neurologists who manage aSAH. A 19-question electronic survey (Survey Monkey) was developed and validated by the CNRC following a DCI-related literature review (PubMed, Embase). The survey was distributed to members of the Canadian Neurosurgical Society and to Canadian members of the Neurocritical Care Society. Responses were analyzed using quantitative and qualitative methods.
The response rate was 129/340 (38%). Agreement among respondents was limited to the need for intensive care unit admission, use of clinical and radiographic monitoring, and prophylaxis for the prevention of DCI. Several inconsistencies were identified. Indications for starting hyperdynamic therapy varied. There was discrepancy in the proportion of patients who felt to require IV milrinone, IA vasodilators, or physical angioplasty for treatment of DCI. Most respondents reported their facility does not utilize a standardized definition for DCI.
DCI is an important clinical entity for which no homogeneity and standardization exists in management among Canadian practitioners. The CNRC calls for the development of national standards in the definition, identification, and treatment of DCI.
迟发性脑缺血（DCI）是动脉瘤性蛛网膜下腔出血（aSAH）的一种并发症，与显著的发病率和死亡率相关。目前几乎没有高质量的证据可用于指导DCI的管理。加拿大神经外科研究协作组（CNRC）由住院医师组成，有能力收集全国多中心的数据。本研究的目的是评估加拿大医生在aSAH和DCI管理方面的实践模式。
我们对管理aSAH的加拿大神经外科医生、重症监护医生和神经科医生进行了横断面调查。在对与DCI相关的文献（PubMed、Embase）进行综述后，CNRC制定并验证了一份包含19个问题的电子调查问卷（Survey Monkey）。该问卷分发给了加拿大神经外科学会的成员以及神经重症监护学会的加拿大成员。使用定量和定性方法对回复进行分析。
回复率为129/340（38%）。受访者之间的共识仅限于需要入住重症监护病房、使用临床和影像学监测以及预防DCI。发现了一些不一致之处。启动高动力治疗的指征各不相同。对于治疗DCI所需静脉注射米力农、动脉内血管扩张剂或物理血管成形术的患者比例存在差异。大多数受访者报告其所在机构没有采用DCI的标准化定义。
DCI是一个重要的临床实体，加拿大从业者在其管理方面不存在同质性和标准化。CNRC呼吁制定DCI定义、识别和治疗的国家标准。
