Assessment of two prophylactic fluid strategies in aneurysmal subarachnoid hemorrhage: A randomized trial

Judit Gál, Béla Fülesdi, Dávid Varga, Babett Fodor, Eszter Varga, Péter Siró, Dániel Bereczki, Sándor Szabó, Csilla Molnár, Judit Gál, Béla Fülesdi, Dávid Varga, Babett Fodor, Eszter Varga, Péter Siró, Dániel Bereczki, Sándor Szabó, Csilla Molnár

Abstract

Objective: To compare the effect of two prophylactic euvolemic fluid strategy regimens on the incidence of cerebral vasospasm and clinical outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH).

Methods: Ninety-six patients with a basal intravenous intake of 15 mL/kg/day of Ringer's lactate solution were included, and an additional 15 to 50 mL/kg/day Ringer's lactate (RL-group) or hydroxyethyl starch 130/0.4 solution (HES-group) was administered to maintain the targeted mean arterial pressure. The primary end point was the occurrence of cerebral vasospasm during the first 14 days. The secondary end points were case fatality, Barthel's index, and Glasgow Outcome Scores (GOS) at 30 days after SAH.

Results: Cerebral vasospasm developed in 42 patients (43.7%), and nine of these events were severe. The vasospasm rate among the RL- and HES-based groups was 25/48 and 17/48, respectively. For the secondary endpoint, four patients (4%) died by the end of follow-up (two in each group). Unfavorable outcome cases were not different in the RL and HES groups (9 vs. 14, respectively). There was no difference between the Barthel's scores at 30 days between the two groups.

Conclusions: Using starches in a prophylactic treatment strategy in aneurysmal SAH in not supported by the study.The trial was registered at Clinicaltrials.gov under the number NCT02064075.

Keywords: Aneurysmal subarachnoid hemorrhage; Barthel’s index; Glasgow outcome score; cerebral vasospasm; euvolemic; hydroxyethyl starch; prophylactic fluid strategy.

Figures

Figure 1.
Figure 1.
Consort flow chart of patient screening and inclusion.
Figure 2.
Figure 2.
Middle cerebral artery mean blood flow velocities in the RL and in the HES based groups. The median and IQR, and the minimum and maximum values are presented. RL, Ringer’s lactate; HES, hydroxyethyl starch; IQR, interquartile range.

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