Neurocritical Care

, Volume 20, Issue 2, pp 277–286 | Cite as

Human Albumin Administration in Subarachnoid Hemorrhage: Results of an International Survey

  • Jose I. Suarez
  • Renee H. Martin
  • Eusebia Calvillo
  • David Zygun
  • Oliver Flower
  • George K. Wong
  • Eric M. Bershad
  • Chethan P. Venkatasubba Rao
  • Alexandros Georgiadis
  • Draga Jichici
  • Peter D. Leroux
Original Article



Subarachnoid hemorrhage (SAH) is a devastating disease. Nimodipine is the only medical treatment shown to improve outcome of SAH patients. Human albumin (ALB) may exert neuroprotection in SAH. However, current usage of ALB in SAH is not known. We conducted an international survey of clinicians involved in the care of SAH patients to determine current practice of ALB administration in SAH.


We constructed a 27-question survey. Our sampling frame consisted of neurointensivists, general intensivists, neurocritical care nurses, critical care pharmacists, and neurosurgeons. The survey was available from 11/15/2012 to 12/15/2012. We performed mostly descriptive statistical analysis.


We obtained 362 responses from a diverse range of world regions. Most respondents were intensivist physicians (88 %), who worked in academic institutions (73.5 %) with a bed capacity >500 (64.1 %) and an established institutional management protocol for SAH patients (70.2 %). Most respondents (83.5 %) indicated that their institutions do not incorporate ALB in their protocol, but half of them (45.9 %) indicated using ALB outside it. ALB administration is influenced by several factors: geographic variation (more common among US respondents); institutions with a dedicated neuroICU; and availability of SAH management protocol. Most respondents (75 %) indicated that a clinical trial to test the efficacy of ALB in SAH is needed.


In this survey we found that ALB administration in SAH patients is common and influenced by several factors. Majority of respondents support a randomized clinical trial to determine the safety and efficacy of ALB administration in SAH patients.


Human albumin Subarachnoid hemorrhage Neuroprotection Outcomes Delayed cerebral ischemia 


  1. 1.
    Goldwasswer P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703.CrossRefGoogle Scholar
  2. 2.
    Foley EF, Borlase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. A prospective randomized trial. Arch Surg. 1990;125:739–42.PubMedCrossRefGoogle Scholar
  3. 3.
    Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998;317:235–40.CrossRefGoogle Scholar
  4. 4.
    Offringa M. Excess mortality after human albumin administration in critically ill patients: clinical and pathophysiological evidence suggests albumin is harmful. BMJ. 1998;317:223–4.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomized trials. BMJ. 1998;316:961–5.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Vermeulen LC, Ratko TA, Erstad BL, et al. A paradigm for consensus: the University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med. 1995;155:373–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Wilkes MM, Navickis RJ. Patient survival after human albumin administration. Ann Intern Med. 2001;135:149–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Roberts I, Blackhall K, Alderson P, Bunn F, Schierhout G. Human albumin solution for resuscitation and volume expansion in critically ill patients. Cochrane Database Syst Rev. 2011;11:CD001208.PubMedGoogle Scholar
  9. 9.
    Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2011;3:CD001319.PubMedGoogle Scholar
  10. 10.
    Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011;3:CD000567.PubMedGoogle Scholar
  11. 11.
    Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.PubMedCrossRefGoogle Scholar
  12. 12.
    Delaney AP, Dan A, McCaffrey J, Finfer S. The role of albumin as resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med. 2011;39:386–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Tanzi M, Gardner M, Megellas M, Lucio S, Restino M. Evaluation of the appropriate use of albumin in adult and pediatric patients. Am J Health Syst Pharm. 2003;60:1330–5.PubMedGoogle Scholar
  14. 14.
    Suarez JI, Shannon L, Zaidat OO, et al. Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage. J Neurosurg. 2004;100:585–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Suarez JI, Martin RH. Treatment of subarachnoid hemorrhage with human albumin: ALISAH study. Rationale and design. Neurocrit Care. 2010;13:263–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Suarez JI, Martin RH, Calvillo E, et al. The Albumin in Subarachnoid Hemorrhage (ALISAH) multicenter pilot clinical trial: safety and neurologic outcomes. Stroke. 2012;43:683–90.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–37.PubMedCrossRefGoogle Scholar
  18. 18.
    Diringer MN, Bleck TP, Claude Hemphill J III, Menon D, Shutter L, Vespa P, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference. Neurocrit Care. 2011;15:211–40.PubMedCrossRefGoogle Scholar
  19. 19.
  20. 20.
    Hill MD, Martin RH, Palesch YY, et al. The albumin in acute stroke part 1 trial: an exploratory efficacy analysis. Stroke. 2011;42:1621–5.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–84.CrossRefGoogle Scholar
  22. 22.
    Macdonald RL, Higashida RT, Keller E, et al. Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid hemorrhage undergoing surgical clipping: a randomized, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol. 2011;10:618–25.PubMedCrossRefGoogle Scholar
  23. 23.
    Macdonald RL, Higashida RT, Keller E, et al. Randomized trial of clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Stroke. 2012;43:1463–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Dorhout Mees SM, Algra A, Vandertop WP, et al. Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial. Lancet. 2012;380:44–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Wong GK, Poon WS, Chan MT, et al. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMASH): a randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke. 2010;41:921–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Ginsberg MD, Palesch YY, Hill MD, et al. High-dose albumin treatment for acute ischaemic stroke (ALIAS) part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurol. 2013;12:1049–58.PubMedCrossRefGoogle Scholar
  27. 27.
    Cooper JD, Myburgh J, Heritier S, et al. Albumin resuscitation for traumatic brain injury: is intracranial hypertension the cause of increased mortality? J Neurotrauma. 2013;30:512–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Kramer AH, Diringer MN, Suarez JI, et al. Red blood cell transfusion in patients with subarachnoid hemorrhage: a multidisciplinary North American survey. Crit Care. 2011;15:R30. doi:10.1186/cc9977.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jose I. Suarez
    • 1
  • Renee H. Martin
    • 2
  • Eusebia Calvillo
    • 1
  • David Zygun
    • 3
  • Oliver Flower
    • 4
  • George K. Wong
    • 5
  • Eric M. Bershad
    • 1
  • Chethan P. Venkatasubba Rao
    • 1
  • Alexandros Georgiadis
    • 1
  • Draga Jichici
    • 6
  • Peter D. Leroux
    • 7
  1. 1.Division of Vascular Neurology and Neurocritical Care, Department of NeurologyBaylor College of MedicineHoustonUSA
  2. 2.Division of Biostatistics and EpidemiologyMedical University of South CarolinaCharlestonUSA
  3. 3.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  4. 4.Division of Intensive Care, North Shore HospitalUniversity of SydneySydneyAustralia
  5. 5.Department of Surgery, Faculty of MedicineChinese University of Hong KongHong KongChina
  6. 6.Department of Neurology and Critical Care MedicineMcMaster UniversityHamiltonCanada
  7. 7.Department of NeurosurgeryThomas Jefferson UniversityPhiladelphiaUSA

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