Evidence based management of aneurysmal subarachnoid haemorrhage an audit of current practice
White S.1, Heald M.2, Sunny S.2, Augustine A.2, Kakkar G.2
Institute(s): 1Royal Wolverhampton NHS Trust, Dept of Anaesthesiology, Wol, United Kingdom, 2University Hospital North Midlands NHS Trust, Dept of Anaesthesiology, Stoke on Trent, United Kingdom

Background and Goal of Study: 
Sub arachnoid haemorrhage (SAH) accounts for 5% of all stroke.
Despite advances in diagnosis and treatment, overall mortality is around 50%. One-third of survivors are dependent for care and almost half will have cognitive impairment sufficient to affect their quality of life.
A multidisciplinary team is involved in patient care and Anaesthetists are involved from the initial stabilization and diagnosis through to providing anaesthesia for definitive treatment and post operative support in critical care. 
Materials and methods: 
We conducted a retrospective audit of paper and electronic records looking at 21 patients who underwent coiling for SAH. The data was collected against the guidelines produced by AHA/ASA 2012 directed towards prevention and treatment of re-bleeding, vasospasm, delayed cerebral ischaemia, hydrocephalus and seizures, to assess current practice at University Hospital North Midlands, UK.
Results and discussion: 
21 patients (19 females and 2 male), age range 25 to 67 years old, mean 54.5 +/- 11.3. One third of aneurysms were multiple and two thirds were single. 15 aneurysms were less than 7mm in size. 
52% of patients were transferred from another hospital.
75% patients were treated within 24hrs 
90% of patients treated within 48 hours. Mean time to treatment was 19 hours. 
100% had nimodipine prescribed and 100% received nimodipine 
38% of patients missed between 2 and 4 doses of nimodipine 
33% of patients received 1st nimodipine dose in hospital >4 hours post admission 
1/21 patients received tranexamic acid. 
50% of patients had a 0 or 1 Modified ranking Scale score at 6 months follow up.
Retrospective collection of data is flawed, but future audit will be improved following introduction of prospectively compiled database.
Pre-operatively patients were managed appropriately as evidenced from good outcomes at 6 months. Improvements could be made in administration of prescribed drugs, in particularly nimodipine for which there is strong evidence for prevention of vasospasm.
Optimal fluid balance and closer blood pressure control can also be improved to avoid secondary brain injury.
Conclusion(s): 
Good practice was observed at UHNM complying with the recommendations of the AHA/ASA for definitive treatment of aneurysm within 72hrs. 
We are introducing a check-list style proforma with key interventions to be signed and dated in front of patient notes to improve and standardise care.