The use of acute normovolemic hemodilution in clipping surgery for aneurysmal subarachnoid hemorrhage.

Chen, Ping; Wang, Ying; Zhang, Xin-Huang; Kang, De-Zhi; Lin, Xian-Zhong; Lin, Qing-Song

BACKGROUND The occurrence of COVID-19 has overwhelmed the blood supply chain worldwide and severely influenced the clinical procedures with potential massive blood loss, such as clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH). Whether acute normovolemic hemodilution (ANH) is safe and effective in aneurysm clipping remains largely unknown. METHODS aSAH patients who underwent clipping surgery within 72 hours from bleeding were included. The patient in the ANH group received 400 mL autologous blood collection, and the blood was returned as needed during surgery. The relationships between ANH and perioperative allogeneic blood transfusion, postoperative outcome, complications were analyzed. RESULTS 62 aSAH patients were included between December 2019 and June 2020, 20 in ANH group and 42 in non-ANH group. ANH did not reduce the need of perioperative blood transfusion (3 [15%] vs 5 [11.9%], P = 0.734). However, ANH significantly increased serum hemoglobin levels on postoperative day 1 (11.5 ± 2.5 g/dL vs 10.3 ± 2.0 g/dL, P = 0.045) and day 3 (12.1 ± 2.0 g/dL vs 10.7 ± 1.3 g/dL, P = 0.002). Multivariable analysis indicated that serum hemoglobin levels on postoperative day 1 (OR =0.895, 95% CI = 0.822-0.973, P = 0.010) was an independent risk factors for unfavorable outcome, and ROC curve analysis showed that it had a comparable predictive power as WFNS grade (Z =0.275, P > 0.05). CONCLUSIONS ANH significantly increased postoperative hemoglobin levels, and it may hold the potential to improve patients' outcomes. Routine use of ANH should be considered in aneurysm clipping surgery.