Effects of early high-dose vasopressor administration in patients after aneurysmal subarachnoid hemorrhage: a retrospective single-center study

Background

Although the use of vasopressors is recommended after aneurysmal subarachnoid hemorrhage (aSAH) to maintain adequate cerebral perfusion pressure, data on potential adverse effects on delayed cerebral ischemia (DCI) are lacking. The aim of this study was to evaluate the effects of early high-dose vasopressor therapy with norepinephrine alone or additional vasopressin on the subsequent occurrence of DCI, DCI-related infarction and functional outcomes.

Methods

Retrospective evaluation of aSAH patients admitted between January 2010 and December 2022. Demographic, clinical and outcome data as well as daily norepinephrine equivalent (NEE) scores were collected. Potential risk factors for DCI, DCI-related infarction and functional outcome 3 months after discharge were assessed by logistic regression analyses.

Results

A total of 288 patients were included. 208 patients (72%) received vasopressor therapy during the first 14 postictal days with a mean NEE score of 3.8 µg/kgBW/h. The highest NEE scores were observed in the acute phase after hemorrhage and mainly in poor-grade patients. The mean NEE score during the postictal days 1–4 was significantly higher in patients who developed DCI or DCI-related infarction and who had an unfavorable functional outcome. Multivariable logistic regression analysis identified a high NEE score on postictal days 1–4 as an independent predictor of DCI and unfavorable functional outcome.

Conclusions

Vasopressor use is common in aSAH patients in the acute phase after hemorrhage. Our results suggest that high NEE scores during the first 4 days after ictus represent an independent prognostic factor and might aggravate the complex cerebral sequelae associated with the disease.