Comparative analysis of two standardised protocols for prevention of vasospasm following aneurysmal subarachnoid haemorrhage: A retrospective pilot study.

BACKGROUND

Cerebral vasospasm is a major complication after subarachnoid haemorrhage. Yet, no standardised applicable therapy regimen has been established so far. Most previous studies concentrated on comparing single drugs, while fewer holistic therapeutic approaches have been compared.

OBJECTIVE

Our objective was to compare two therapy bundles with different administrations of magnesium, catecholamines, nimodipine and molsidomine, regarding the prevention of cerebral vasospasm and neurological outcome after subarachnoid haemorrhage.

DESIGN

Retrospective design, pilot study.

SETTING

This single-centre trial included 44 patients, 22 patients per group (matched pairs), with aneurysmal subarachnoid haemorrhage treated in the hospital of Barmherzige Brüder in Regensburg, Germany, from 2015 to 2022. Exclusion criteria were known comorbidities, such as severe liver, blood or kidney diseases.

MAIN OUTCOME MEASURES

Incidence of vasospasm, survival and clinical outcome.

RESULTS

The incidence of vasospasms showed no significant difference between group 1 (new therapy bundle) and group 2 (previous standard therapy,  = 0.34), as well as the number of surviving patients. Comparing the clinical outcome measured with the Glasgow Outcome Scale after hospitalisation, no significant difference could be seen. The hospital length of stay, group 1: 23 [16.75 to 25.50] days vs. group 2: 30 [22.5 to 34.5] days,  = 0.004, and the intensive care unit (ICU) length of stay (LOS), group 1: 17.50 [12.75 to 24.00] days vs. group 2: 23.50 [19.75 to 32.50] days,  = 0.012, were significantly shorter in group 1.

CONCLUSION

New therapy bundle has the potential to be more effective than the standard therapy method. As a retrospective pilot study with a small sample size, this research may serve as a valuable foundation for future larger prospective studies for better comparison of the different therapeutic approaches.