Affiliation:
1. Hamad Medical Corporation
Abstract
Abstract
Background
This study reviews the effect of albumin-induced volume expansion therapy on symptomatic vasospasm and clinical outcome in aneurysmal subarachnoid hemorrhage (SAH) and evaluates the outcomes to those associated with use of albumin among the comparison groups.
Methods
Computer searches carried out from the Scopus, Medline, Embase, Web of Science, the Cochrane Library, and Internet documents; hand searching of medical journals; and review of reference lists. Randomized, controlled trials (RCT) and observational studies comparing albumin therapy in combination or alone with crystalloid therapy for treatment of cerebral vasospasm in aneurysmal SAH.
Results
Out of total 1078 searches, one RCT (published in two articles) and one observational (retrospective) study were included for final analysis. In RCT, albumin used for volume expansion therapy with a baseline crystalloid regime and comparison made between hypervolemic and normovolemic groups and it showed no beneficial effects for symptomatic vasospasm and clinical outcomes based on GOS. Also, use of albumin showed a tendency for sodium retention with lowering of GFR to avoid fluid overload manifestations. The retrospective study results between albumin versus non-albumin groups (crystalloids only) supported improved outcomes in former with lower in-hospital mortality. Cardio-respiratory complications were equivocal in RCT and increased in non-albumin group in retrospective study. Meta-analysis was not conducted due to heterogeneity of data.
Conclusion
Albumin-induced volume expansion therapy for cerebral vasospasm does not have substantiative evidence to improve cerebral vasospasm and clinical outcome in aneurysmal SAH. Studies with well-designed RCT’s are required to compare the use of albumin for volume expansion therapy versus standard fluid management using crystalloids to mitigate the scarcity of published data.
Publisher
Research Square Platform LLC