Jugular bulb oximetry for prediction of vasospasm following subarachnoid hemorrhage.
BACKGROUND
Cerebral vasospasm adversely impacts the outcome of those suffering aneurysmal subarachnoid hemorrhage (SAH). Prediction of vasospasm could improve outcomes. We hypothesized that preclinical vasospasm would be heralded by an increase in cerebral oxygen extractions (AVDO2) which could be detected by jugular bulb oximetry. A pilot study was conducted to address this hypothesis.


METHODS
Fourteen consenting patients with aneurysmal SAH, undergoing early surgery, were entered into the study. Four patients were withdrawn from the study secondary to failure of catheters or religious belief. At the time of craniotomy, a jugular bulb catheter was placed. Post-operatively, arterial and jugular bulb blood samples were taken every 12 hours to calculate AVDO2. As this was an observational study, no change in management occurred based on measurements.


RESULTS
Four of 10 patients had clinical vasospasm. These patients had a significant rise in AVDO2 approximately one day prior to the onset of neurologic deficits (P<0.001). Symptoms resolved along with a significant improvement in AVDO2 on instituting hypertensive, hemo-dilutional, and hypervolemic therapy in these patients. The six patients who did not exhibit clinical vasospasm did not demonstrate significant rise in AVDO2.


CONCLUSIONS
Jugular bulb oximetry is simple and cost effective. Increases in AVDO2 using this technique were predictive of clinically evident vasospasm in the subsequent hours to days. This investigation supports a larger study to assess the utility of jugular bulb oximetry in predicting vasospasm in aneurysmal SAH.
Heran
Navraj S
NS
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Hentschel
Stephen J
SJ
Toyota
Brian D
BD
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000378:metabolism*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000378:metabolism*