Six-month mortality and functional outcomes in aneurysmal sub-arachnoid haemorrhage patients admitted to intensive care units in Australia and New Zealand: A prospective cohort study

Historical studies suggest survivors of aneurysmal sub-arachnoid haemorrhage (SAH) have at least a moderate burden of functional impairment. However, there is a paucity of modern data concerning these outcomes in those admitted to the intensive care unit (ICU). Accordingly, the aim of this multicentre prospective observational cohort study was to provide contemporary epidemiological data concerning 6-month outcomes of adult aneurysmal SAH patients admitted to ICU in Australia and New Zealand (ANZ). Between March 2016 and June 2018 (inclusive), 357 patients requiring ICU admission were enrolled into the study, from eleven (n = 11) neurosurgical centres in ANZ. The majority of patients were female (n = 242, 68%), the median [IQR] age was 57 [49, 67] years, and almost all were living independently prior to their SAH (n = 337, 94%). 38% (n = 134) suffered a high-grade (WFNS 4–5) SAH. The median index ICU and hospital lengths of stay (LOS) were 9 [4–14], and 20 [13–29] days, respectively. In-hospital mortality was 22% (n = 77). Of the evaluable cohort (n = 348), a further nine (n = 9) patients had died by 6-months, yielding an all cause mortality of 25% (n = 86). Moreover, 35% (n = 114) of assessable patients were ‘dead or disabled’ (modified Rankin scale ≥4) at 6-months, and there was significant variation between sites, independent of SAH severity. Overall, these patients consumed substantial healthcare resources, and given the burden of mortality and morbidity, in addition to the variability between institutions, there may be opportunity to improve patient outcomes.