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The effects of continuous prostacyclin infusion on regional blood flow and cerebral vasospasm following subarachnoid haemorrhage: study protocol for a randomised controlled trial

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Author

  • Rune Rasmussen
  • Jorn Wetterslev
  • Trine Stavngaard
  • Jane Skjoth-Rasmussen
  • Per-Olof Grände
  • Niels Vidiendal Olsen
  • Bertil Romner

Summary, in English

Background: One of the main causes of mortality and morbidity following subarachnoid haemorrhage (SAH) is the development of cerebral vasospasm, a frequent complication arising in the weeks after the initial bleeding. Despite extensive research, to date no effective treatment of vasospasm exists. Prostacyclin is a potent vasodilator and inhibitor of platelet aggregation. In vitro models have shown a relaxing effect of prostacyclin after induced contraction in cerebral arteries, and a recent pilot trial showed a positive effect on cerebral vasospasm in a clinical setting. No randomised, clinical trials have been conducted, investigating the possible pharmacodynamic effects of prostacyclin on the human brain following SAH. Methods: This trial is a single-centre, randomised, placebo-controlled, parallel group, blinded, clinical, pilot trial. A total of 90 patients with SAH will be randomised to one of three intervention arms: epoprostenol 1 ng/kg/min, epoprostenol 2 ng/kg/min or placebo in addition to standard treatment. Trial medication will start day 5 after SAH and continue to day 10. The primary outcome measure is changes in regional cerebral blood flow from baseline in the arterial territories of the anterior cerebral artery, medial cerebral artery and the posterior cerebral artery, measured by CT perfusion scan. The secondary outcomes will be vasospasm measured by CT angiography, ischaemic parameters measured by brain microdialysis, flow velocities in the medial cerebral artery, clinical parameters and outcome (Glasgow Outcome Scale) at 3 months.

Publishing year

2012

Language

English

Publication/Series

Trials

Volume

13

Document type

Journal article

Publisher

BioMed Central (BMC)

Topic

  • Anesthesiology and Intensive Care

Keywords

  • Subarachnoid haemorrhage
  • Prostacyclin
  • Epoprostenol
  • Vasospasm
  • Delayed
  • ischaemic neurological deficit

Status

Published

ISBN/ISSN/Other

  • ISSN: 1745-6215