Beta Blockade and Clinical Outcomes in Aneurysmal Subarachnoid Hemorrhage
Melody M. Chang1, Ronak N. Raval1, *, Jessie J. Southerland2, Dare A. Adewumi3, Khaled A. Bahjri4, Rajeev K. Samuel1, Rafeek O. Woods1, Olaide O. Ajayi1, Bryan S. Lee5, Frank P. K. Hsu6, Richard L. Applegate II7, Ihab R. Dorotta1
Department of Anesthesiology, Loma Linda University School of Medicine, CA, USA
Department of Anesthesiology, San Juan Regional Medical Center, USA
Department of Neurosurgery, The Greater Houston Neurosurgery Center, TX, USA
School of Public Health, Loma Linda University, CA, USA
Department of Neurosurgery, Cleveland Clinic Foundation, Ohio, USA
Department of Neurosurgery, University of California, Irvine, USA
Department of Anesthesiology, University of California, Davis, USA
Aneurysmal subarachnoid hemorrhages are frequently complicated by hypertension and neurogenic myocardial stunning. Beta blockers may be used for management of these complications. We sought to investigate sympathetic nervous system modulation by beta blockers and their effect on radiographic vasospasm, delayed cerebral infarction, discharge destination and death.
Retrospective chart review of 218 adults admitted to the ICU between 8/2004 and 9/2010 was performed. Groups were identified relevant to beta blockade: 77 were never beta blocked (No/No), 123 received post-admission beta blockers (No/Yes), and 18 were continued on their home beta blockers (Yes/Yes). Records were analyzed for baseline characteristics and the development of vasospasm, delayed cerebral infarction, discharge destination and death, expressed as adjusted odds ratio.
Of the 218 patients 145 patients developed vasospasm, 47 consequently infarcted, and 53 died or required care in a long-term facility. When compared to No/No patients, No/Yes patients had significantly increased vasospasm (OR 2.11 (1.06-4.16)). However, these patients also had significantly fewer deaths or need for long term care (OR 0.17 (0.05-0.64)), with decreased tendency for infarcts (OR 0.70 (0.32-1.55)). When compared to No/No patients, Yes/Yes patients demonstrated a trend toward increased vasospasm (OR 1.61 (0.50-5.29)) that led to infarction (OR 1.51 (0.44-5.13)), but with decreased mortality or need for long term care in a facility (OR 0.13 (0.01-1.30)).
Post-admission beta blockade in aneurysmal subarachnoid hemorrhage patients was associated with increased incidence of vasospasm. However, despite the increased occurrence of vasospasm, beta blockers were associated with improved discharge characteristics and fewer deaths.
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* Address correspondence to this author at the Department of Anesthesiology, Loma Linda University School of Medicine, 11234 Anderson St, Loma Linda, CA 92354, USA; Tel: 909-558-4000; Ex. 47430; Fax: 909-558-4143; E-mail: firstname.lastname@example.org