Abstract Details

Title Cerebral hypoperfusion after nimodipine administration is associated with worse functional outcomes in subarachnoid hemorrhage patients

Topic Neuro Trauma and Critical Care

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 1-001

Background Impairment of cerebral autoregulation after subarachnoid hemorrhage (SAH) makes patients vulnerable to changes in blood pressure (BP). While oral nimodipine is recommended for improving neurological outcomes, its administration is frequently associated with reductions in BP. In this observational study, we examined the effect of nimodipine-induced BP reductions below personalized limits of autoregulation on outcome after aneurysmal SAH.

Objective To explore the effect of nimodipine-induced episodes of cerebral hypoperfusion on functional outcomes in subarachnoid hemorrhage patients.

Design/Methods Autoregulatory function was continuously measured by interrogating changes in near-infrared spectroscopy-derived tissue oxygenation (a cerebral blood flow surrogate) in response to changes in mean arterial pressure (MAP). The resulting autoregulatory index identified optimal MAP (MAPopt) and limits at which autoregulation is most preserved for each patient. Cerebral hypoperfusion was defined as episodes with at least 30 minutes of MAP reductions below the lower limit of autoregulation (LLA) following nimodipine administration. Functional outcome was measured with the modified Rankin Scale at 90 days.

Results We identified 593 occurrences of nimodipine administration with simultaneous recording of continuous physiologic data for 60 minutes before and after the intervention among 26 SAH patients (age 57 + 14, 80% female, median monitoring time 3.2 days). Following nimodipine administration, the median MAP decreased from 103 to 98 mmHg (p<0.001), and the median percent time with MAP below the LLA increased from 0 to 11% (p<0.001). Median MAPopt remained relatively unchanged (p=0.06). Moreover, the proportion of episodes with cerebral hypoperfusion was associated with worse 90-day outcomes after adjusting for age and SAH severity (OR for 10% increase 1.5, 95% CI 1.2-2.2, P=0.038).

Conclusions

Nimodipine-induced BP reductions below the LLA may increase the risk of secondary brain injury and poor functional outcomes. A more personalized treatment approach accounting for cerebral autoregulation status could help identify vulnerable patients and maximize the benefit from current clinical interventions.

Authors/Disclosures
David Bartolome (Yale University School of Medicine) PRESENTER	Mr. Bartolome has nothing to disclose.
Yelyzaveta Begunova	Miss Begunova has nothing to disclose.
Ayush Prasad (Yale School of Medicine & Yale - New Haven Hospital)	Mr. Prasad has nothing to disclose.
Alexandria Soto	Ms. Soto has nothing to disclose.
Jessica Kobsa (Yale University)	Ms. Kobsa has nothing to disclose.
Ilayda Top (Yale University)	Ms. Top has nothing to disclose.
Darko E. Quispe Orozco, MD (TTUHSC-SOM, Lubbock; Neurology Dept.)	Dr. Quispe Orozco has nothing to disclose.
Mudassir Farooqui, MD	Dr. Farooqui has nothing to disclose.
	No disclosure on file
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Rachel Beekman, MD (Yale New Haven Medical Center)	Dr. Beekman has nothing to disclose.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Charles Matouk	No disclosure on file
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.
Nils Petersen, MD (Yale University)	Dr. Petersen has received research support from NIH.