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.