Cerebral Hemodynamic Optimization by Milrinone to Prevent Delayed Cerebral Ischemia

After SAHa, approximately 28% of patients will present DCI. DCI is a major cause of death and disability and will condition the neurological prognosis. Its treatment is not really codified, because of the absence of scientific proof of good level. Milrinone, an inhibitor of type III phosphodiesterase, seems particularly interesting in the management of DCI. This molecule has indeed a powerful vasodilator action. In addition, its anti-inflammatory effects could inhibit the abnormal proliferation of vascular smooth muscle cells and the remodelling observed in patients with DCI via an action on interleukin-6. Finally, because of its positive inotropic effect, it is an interesting choice in these patients with neurogenic cardiomyopathy where the administration of catecholamines is to be avoided. Strong evidence for efficacy of milrinone in the treatment and / or prevention of DCI is still lacking. All patients will benefit from a computed tomography (CT) brain imaging at 48 hrs following aneurysm treatment to define baseline imaging. The standard care (SC) group will follow the recommended management of SAHa and will receive a placebo (intravenous glucose 5%) from day 4 to day 14. The milrinone (M) group will receive, in addition to standard care, administration of milrinone (0.75 μg / kg / min, intravenous) from day 4 to day 14. In case of suspicion of vasospasm and after ineffective effect of medical measures (euvolemia and increase in mean arterial pressure), an endovascular treatment will be possible. The occurrence of vasospasm will be monitored closely with clinical examination and cerebral tissue oxygen pressure (PtiO2). From day 4 to day 14, general and biological data, clinical examination will be collected daily. Intensive care unit complications (neurologic, pulmonary, cardiac and septic complications) will be collected. At 1 month, the volume of DCI lesions will be measured on CT scan. Neurologic prognosis, quality of life and mortality will be studied at 1 month, 3 month, 6 month and 1 year. Adverse events will be monitored closely.

• Radiological parameters on CT at 1 month [Срок оценки: 1 month]
• Evolution in intensive care: Neurological complications 1 [Срок оценки: 1 month]
• Evolution in intensive care: Neurological complications 2 [Срок оценки: 1 month]
• Evolution in intensive care: Neurological complications 3 [Срок оценки: 1 month]
• Evolution in intensive care: Neurological complications 4 [Срок оценки: 1 month]
• Number and type of non-neurological complications [Срок оценки: 1 month]
• Number of days in intensive care [Срок оценки: 1 month]
• Number of days with mechanical ventilation [Срок оценки: 1 month]
• neurological prognosis at 1 month: Rankin score [Срок оценки: 1 month]
• neurological prognosis at 1 month: Glasgow Outcome scale [Срок оценки: 1 month]
• neurological prognosis at 3 month: Rankin score [Срок оценки: 3 month]
• neurological prognosis at 3 month: Glasgow Outcome scale [Срок оценки: 3 month]