Prospective, Randomized Trial of Higher Goal Hemoglobin after Subarachnoid Hemorrhage

• Published in: Neurocritical care 2010-12, Vol.13 (3), p.313-320
• Main Authors: Naidech, Andrew M., Shaibani, Ali, Garg, Rajeev K., Duran, Isis M., Liebling, Storm M., Bassin, Sarice L., Bendok, Bernard R., Bernstein, Richard A., Batjer, H. Hunt, Alberts, Mark J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anemia; Anemia - blood; Anemia - epidemiology; Anemia - therapy; Aneurysms; Blood; Cardiovascular disease; Catheters; Cerebral Infarction - blood; Cerebral Infarction - epidemiology; Cerebral Infarction - pathology; Consent; Critical Care - methods; Critical Care - statistics & numerical data; Critical Care Medicine; Edema; Enrollments; Erythrocyte Transfusion; Female; Hemoglobin; Hemoglobins - metabolism; Hemorrhage; Hospitals; Humans; Hypotheses; Intensive; Internal Medicine; Ischemia; Magnetic Resonance Imaging; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Mortality; Neurology; Original Article; Patients; Pilot Projects; Prospective Studies; Risk Factors; Stroke; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - epidemiology; Subarachnoid Hemorrhage - pathology; Surgeons; Treatment Outcome; Vasospasm, Intracranial - blood; Vasospasm, Intracranial - epidemiology; Vasospasm, Intracranial - pathology; Ventilation; Ventilators
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-010-9424-4

Background and Purpose In patients with subarachnoid hemorrhage (SAH), higher hemoglobin (HGB) has been associated with better outcomes, but packed red blood cell (PRBC) transfusions with worse outcomes. We performed a prospective pilot trial of goal HGB after SAH. Methods Forty-four patients with SAH and high risk for vasospasm were randomized to goal HGB concentration of at least 10 or 11.5 g/dl. We obtained blinded clinical outcomes at 14 days (NIH Stroke Scale and modified Rankin Scale, mRS), 28 days (mRS), and 3 months (mRS), and blinded interpretation of brain MRI for cerebral infarction at 14 days. This trial is registered at www.stroketrials.org . Results Forty-four patients were randomized. Patients with goal HGB 11.5 g/dl received more PRBC units per transfusion [1 (1–2) vs. 1 (1–1), P   0.1 for all). Conclusions Higher goal hemoglobin in patients with SAH seems to be safe and feasible. A phase III trial of goal HGB after SAH is warranted.