Affiliation:
1. From the Wessex Neurological Centre, University Hospital Southampton, Southampton, UK (D.O.B., A.A.B., I.T., K.S., R.L., D.L.) and The Hospital for Sick Children, Toronto, Ontario, Canada (E.H.).
Abstract
Background and Purpose—
To assess whether prophylactic postoperative intraaortic balloon counterpulsation (IABC) reduces the risk of poor outcome because of vasospasm following aneurysmal subarachnoid haemorrhage relative to conventional hypervolemic therapy (HT).
Methods—
This was a single-center, parallel group randomized controlled trial. Patients suffering a subarachnoid hemorrhage at high risk of vasospasm were eligible. Patients were randomly allocated to receive prophylactic IABC (n=35) or HT (n=36). The primary end point was Glasgow Outcome and SF-36 scores assessed at 6 months by a blinded and independent observer and analyzed by intention to treat. Secondary analysis of physiological parameters was by treatment performed.
Results—
Twenty-seven patients in each arm had a good outcome (
P
=0.55). There was no statistical difference in mean SF-36 score (t=0.39,
P
=0.70). There were no long-term complications secondary to IABC. There were no differences in preload (pulmonary artery wedge pressure,
P
=0.97) or afterload (mean arterial pressure,
P
=0.97). IABC was associated with a lower cardiac output (
P
=0.002) and higher systemic vascular resistance (
P
=0.005), although for both groups mean cardiac output was >6 L/min. Cerebral blood flow was not different between groups: HT=41.5 (SD 7.2), IABP=44.9 (SD 8.6) mL/100 g/min (
P
=0.14).
Conclusions—
In this study, prophylactic IABC did not improve perfusion indices or confer any clinical benefit following subarachnoid haemorrhage in patients with normal cardiac function. The study was small, however, and cannot be extrapolated to patients with cardiac failure and medically refractory symptomatic cerebral vasospasm.
Clinical Trial Registration—
This trial was not registered because enrolment began prior to July 1, 2005.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
13 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献