Intensive care of aneurysmal subarachnoid hemorrhage: an international survey

Background  Patients with aneurysmal subarachnoid hemorrhage (SAH) are routinely admitted to the intensive care unit for the management of neurological and systemic complications. Objective  To determine the clinical practices of intensive care physicians treating SAH, and to evaluate the relationship between these practices and published evidence. Design  Survey. Participants  Physicians identified through the Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine (ESICM), and the Neurocritical Care Society (NCS). Interventions  The research team classified published clinical research on key interventions in SAH diagnosis and therapy, and then generated a 45-item online questionnaire which was distributed to SCCM, NCS, and ESICM members. Results  There were 626 completed surveys, 51% from the USA or Canada, 35% from Europe, and 14% from other regions. Respondents included anesthesiologists (38%), internists (29%), neurologists (14%), and neurosurgeons (8%). Agreement with selected evidence-based recommendations was variable (39–92%) and did not depend on the quality of the supporting data. Significant practice differences were noted between respondents from North America and Europe, and between those working in high and low-volume centers (respectively >40 and ≤40 SAH cases per year). Conclusions  This study demonstrates that the practices of intensive care physicians treating SAH are heterogeneous and often at variance with available evidence. Electronic supplementary material  The online version of this article (doi:) contains supplementary material which is available to authorized users. The study was support by a grant from the Neurosciences Critical Care Division, Johns Hopkins University School of Medicine; it was endorsed by the Society for Critical Care Medicine, the European Society of Intensive Care Medicine, and the Neurocritical Care Society.