Brain Bleeds May Require Immediate Transfer

Aneurysmal subarachnoid hemorrhage guidelines updated to suggest transfer may be necessary

(RxWiki News) Doctors may need to immediately transfer patients that arrive at the hospital after suffering a certain kind of brain bleed to a more experienced facility.

A scientific statement released by the American Heart Association suggests that those suffering from aneurysmal subarachnoid hemorrhage be transferred to a medical facility that treats at least 35 cases a year.

"Avoid smoking to lower your chance of an aneurysm."

E. Sander Connolly, Jr., MD, chair of the statement writing group, noted that admitting patients to hospitals that see a higher volume of the specific type of aneurysm is associated with lower disability and death. He said the reasons were not clear, though he emphasized that such high-volume facilities have access to experienced specialists and neuro-intensive care services.

Studies have found that 30-day fatality rates are significantly higher at low-volume facilities, fewer than 10 patients a year, at 39 percent, compared to a 27 percent death rate at hospitals that treat more than 35 aneurysm patients a year.

Aneurysmal subarachnoid hemorrhage occurs when a weak blood vessel deep in the brain expands, then ruptures, causing bleeding around the brain. It leads to 5 percent of all strokes, and affects about 30,000 in the U.S. each year.

Avoiding smoking and excessive alcohol consumption, and managing high blood pressure are still recommended to help prevent an aneurysm.

They are usually treated through a microsurgical procedure to clip the damaged area of blood vessel, or by placing detachable metal coils within the aneurysm, a less-invasive procedure.

American Heart Association authors recommend controlling blood pressure and maintaining cerebral perfusion pressure, or brain blood flow. They also suggest delaying follow up imaging after microsurgical clipping or coiling unless there is a compelling reason to do so immediately.

Dr. Connolly said physicians should act quickly if they detect symptoms such as a sudden severe headache, that could be accompanied by vomiting, confusion, loss of consciousness and seizures. He said the guidelines are just a starting point for improving the outcome of patients with aneurysms.

“Most people do not recognize when a (aneurysmal subarachnoid hemorrhage) is occurring, and anyone who experiences the ‘worst headache of your life,’ should get to the closest ER immediately,” Dr. Connolly said.

The guidelines, an update from 2009, were recently published in Stroke, an American Heart Association Journal.

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Review Date: 
May 4, 2012