Barbiturate coma for severe, refractory vasospasm following subarachnoid haemorrhage

Objective:To document the outcome of patients treated with barbiturate coma for severe symptomatic angioplasty-resistant vasospasm. To compare mortali ty with that predicted by admission APACHE II score, and neurological outco me with that of historical controls treated with barbiturate coma for vasos pasm, and with historical controls with delayed ischaemic deficits from vas ospasm treated with nimodipine. Design: Cohort study. Setting: Neurosurgical Intensive Care Unit of tertiary referral university teaching hospital. Patients: Eleven (6.7 %) of 164 consecutive patients with aneurysmal SAH ma naged according to our protocol who were treated with thiopentone-induced b urst suppression coma for severe symptomatic, angioplasty-resistant vasospa sm. Interventions: Chart, database and literature review. Measurements and results: All 11 patients survived to hospital discharge (m ortality 0 %) compared with first-day APACHE II predicted mortality of 30.6 % (p = 0.15). Outcome at 6 months was: good recovery 8/11 (72.7 %), modera te disability 2/11 (18.2 %), vegetative survival 1/11 (9.1 %), Ten of 11 (9 0.9 %) had a good neurological outcome compared with 50.6 % of historical c ontrols with delayed ischaemic deficit from vasospasm (odds ratio 9.78, 95 % confidence interval 1.24-77.0, p = 0.02, and 0 % of previously reported p atients treated with barbiturate coma for vasospasm (p < 0.01). Conclusion: Our results are better than previously published outcomes and s uggest formal evaluation of barbiturate coma in the treatment of severe res istant symptomatic vasospasm following SAI;I is warranted.