Circulatory volume expansion therapy for aneurysmal subarachnoid haemorrhage

  • Review
  • Intervention




Secondary ischaemia is a frequent complication after aneurysmal subarachnoid haemorrhage (SAH), and responsible for a substantial proportion of patients with poor outcome after SAH. The cause of secondary ischaemia is unknown, but hypovolaemia and fluid restriction are important risk factors. Therefore, volume expansion therapy (hypervolaemia) is frequently used in patients with SAH to prevent or treat secondary ischaemia.


To determine the effectiveness of volume expansion therapy for improving outcome in patients with aneurysmal SAH.

Search methods

We searched the Cochrane Stroke Group Trials Register (last searched September 2003). In addition we searched MEDLINE (1966 to January 2004) and EMBASE (1980 to January 2004) and contacted trialists to identify further published and unpublished studies.

Selection criteria

All randomised controlled trials of volume expansion therapy in patients with aneurysmal SAH. We also sought controlled trials based on consecutive groups of patients quasi-randomly allocated to treatment or control group and included these in the analysis if the two groups were well comparable with regard to major prognostic factors.

Data collection and analysis

Two reviewers independently extracted the data and assessed trial quality. Trialists were contacted to obtain missing information.

Main results

We identified three trials. One truly randomised trial and one quasi-randomised trial with comparable baseline characteristics for both groups were included in the analyses. Volume expansion therapy did not improve outcome (Relative Risk (RR) 1.0; 95% Confidence Interval (CI) 0.5 to 2.2), nor the occurrence of secondary ischaemia (RR 1.1; 95% CI 0.5 to 2.2). Hypervolaemia tended to increase the rate of complications (RR 1.8; 95% CI 0.9 to 3.7) In another quasi-randomised trial, outcome assessment was done only at the day of operation (7 to 10 days after SAH). In the period before operation, treatment resulted in a reduction of secondary ischaemia (RR 0.33; 95% CI 0.11 to 0.99) and case fatality (RR 0.20; 95% CI 0.07 to 1.2).

Authors' conclusions

The effects of volume expansion therapy have been studied properly in only two trials of patients with aneurysmal SAH, with very small numbers. At present, there is no sound evidence for the use of volume expansion therapy in patients with aneurysmal SAH.








我們搜尋Cochrane Stroke Group Trials Register(搜尋至2003年9月)。此外我們也搜尋MEDLINE(1966年至2004年1月)和EMBASE(1980年至2004年1月),並且聯絡試驗者以確認更多已發表和未發表的研究。


容積擴張治療用於動脈瘤性SAH病人的所有隨機對照試驗(randomised controlled trial)。我們同時尋找的對照試驗是基於連續幾組的病人被半隨機(quasirandom)地分派到治療與對照組的;如果這兩組病人在主要的預後因子方面是很相稱的,我們則在分析中納入這些試驗。




我們確認了3個試驗。一個真正的隨機試驗以及一個兩組基本特徵相稱的半隨機試驗,被納入分析。容積擴張治療並不能改善預後(相對風險(Relative Risk, RR) 1.0; 95% CI 0.5 to 2.2),或是次發性缺血的發生(RR 1.1; 95% CI 0.5 to 2.2)。高容積血症傾向會增加併發症的機率(RR 1.8; 95% CI 0.9 to 3.7)。在另一個半隨機試驗裡,預後評估只做在手術的那一天(SAH後7到10天)。在手術前的期間,治療結果減少了次發性缺血的產生(RR 0.33; 95% CI 0.11 to 0.99)以及個案死亡率(RR 0.20; 95% CI 0.07 to 1.2)。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Circulatory volume expansion therapy for aneurysmal subarachnoid haemorrhage

There is no evidence that administration of large volume of fluids is beneficial in patients with subarachnoid haemorrhage. Subarachnoid haemorrhage is a subset of stroke that occurs frequently in relatively young persons (mostly 40 to 60 years of age). Secondary ischaemia is an important contributor to poor outcome after a subarachnoid haemorrhage (half the patients die within a month after the haemorrhage). This type of ischaemia occurs 4 to 10 days (hence: secondary) after the haemorrhage, possibly due to fluid loss through increased urinary production. This review shows that there is no evidence to support giving additional fluids to not only compensate for the loss of fluid but also to increase the amount of fluid in the body.