Management of acute subarachnoid hemorrhage in advanced critical care emergency center

A retrospective analysis has been investigated about the optimal perioperative management of 200 consective subarachnoid hemorrhage (SAH) patients admitted to the Advanced Critical Care Emergency Center of Nippon Medical School in recent two years. 82 cases were males and 118 cases were females. Of the 200 patients, 130 were in poor grade (grade IV and V) including 27 patients in cardiopulmonary arrest (CPA) condition. 89% of the patients were group 3 and 4 according to Fisher CT classification. The algorithm in the acute management of SAH can be classified into prehospital phase and hospital phase. The hospital phase can be further classified into resuscitative phase, diagnostic phase, operative phase and postoperative neurointensive care phase. Of 21 patients with rebleeding, 6 cases were in prehospital phase and 6 cases were in diagnostic phase. Based on these findings, in prehospital phase strict control of blood pressure and sedation is recommended during transfer. Three dimentional CT angiography is less invasive and very useful in the perioperative management of SAH. The introduction of endovascular occlusion with GDC coil and brain hypothermial treatment will have the possibility of improving the overall prognosis of severe SAH.