Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Goldwasswer P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  3. Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998;317:235–40.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  7. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. Ann Intern Med. 2001;135:149–64.

    Article  CAS  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  9. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2011;3:CD001319.

    PubMed  Google Scholar 

  10. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011;3:CD000567.

    PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  15. Suarez JI, Martin RH. Treatment of subarachnoid hemorrhage with human albumin: ALISAH study. Rationale and design. Neurocrit Care. 2010;13:263–77.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  19. https://www.surveymonkey.com/.

  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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–84.

    Article  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, 1 Baylor Plaza, NB:320, Houston, TX, 77030, USA

    Jose I. Suarez, Eusebia Calvillo, Eric M. Bershad, Chethan P. Venkatasubba Rao & Alexandros Georgiadis

  2. Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Renee H. Martin

  3. Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AL, Canada

    David Zygun

  4. Division of Intensive Care, North Shore Hospital, University of Sydney, Sydney, SW, Australia

    Oliver Flower

  5. Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China

    George K. Wong

  6. Department of Neurology and Critical Care Medicine, McMaster University, Hamilton, ON, Canada

    Draga Jichici

  7. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Peter D. Leroux

Authors
  1. Jose I. Suarez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renee H. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eusebia Calvillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Zygun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oliver Flower
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George K. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eric M. Bershad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chethan P. Venkatasubba Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexandros Georgiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Draga Jichici
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Peter D. Leroux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jose I. Suarez.

Appendix

Appendix

Human Albumin Administration for Neuroprotection in Subarachnoid Hemorrhage (SAH) survey

  1. 1.

    Select your title (select all that apply):

    1. a.

      M.D.

    2. b.

      Ph.D.

    3. c.

      D.O.

    4. d.

      R.N.

    5. e.

      Director of neuroicu

    6. f.

      Staff intensivist

    7. g.

      Neurosurgeon

    8. h.

      Other (state):__________

  2. 2.

    Select number of years in practice, since training:

    1. a.

      <5

    2. b.

      6–10

    3. c.

      11–15

    4. d.

      16–20

    5. e.

      >21

  3. 3.

    Select type of hospital (select all that apply):

    1. a.

      Academic/University affiliated

    2. b.

      Private

    3. c.

      Community

    4. d.

      Tertiary care

    5. e.

      Suburban

    6. f.

      Urban

  4. 4.

    Select location of your hospital:

    1. a.

      US

    2. b.

      Canada

    3. c.

      European Union

    4. d.

      Latin America

    5. e.

      Australia and New Zealand

    6. f.

      Hong Kong

    7. g.

      Other (please indicate): _____________________________________

  5. 5.

    Number of hospital beds:

    1. a.

      ≤250

    2. b.

      251–500

    3. c.

      501–750

    4. d.

      751–1,000

    5. e.

      1,001–1,250

    6. f.

      1,251–1,500

    7. g.

      >1,500

  6. 6.

    Number of SAH patients per year admitted to your hospital:

    1. a.

      ≤20

    2. b.

      21–40

    3. c.

      41–60

    4. d.

      61–100

    5. e.

      >101

  7. 7.

    Are SAH patients admitted to a dedicated neuroICU in your hospital?

    1. a.

      Yes

    2. b.

      No

  8. 8.

    Number of beds in your ICU where SAH patients are admitted:

    1. a.

      ≤10

    2. b.

      11–15

    3. c.

      16–20

    4. d.

      ≥20

  9. 9.

    Does your hospital have a protocol for SAH care?

    1. a.

      Yes

    2. b.

      No

  10. 10.

    If the answer is Yes, does your protocol include human albumin administration?

    1. a.

      Yes

    2. b.

      No

  11. 11.

    If the answer is Yes, what concentration of human albumin does your protocol allow (select all that apply)?

    1. a.

      4 %

    2. b.

      5 %

    3. c.

      20 %

    4. d.

      25 %

  12. 12.

    If the answer is No, do you administer human albumin to your SAH patients outside a set protocol?

    1. a.

      Yes

    2. b.

      No

  13. 13.

    If the answer is Yes, what concentration of human albumin do you administer outside a set protocol (select all that apply)?

    1. a.

      4 %

    2. b.

      5 %

    3. c.

      20 %

    4. d.

      25 %

  14. 14.

    If you administer human albumin to SAH patients please select below the indication(s) (select all that apply):

    1. a.

      Maintenance of normovolemia

    2. b.

      Maintenance of hypervolemia

    3. c.

      Delayed Cerebral Ischemia

    4. d.

      Hypoalbuminemia

    5. e.

      Volume resuscitation in the setting of hypotension

    6. f.

      Neuroprotection

    7. g.

      Other (please list):_______________________________

    8. h.

      I do not administer human albumin in SAH

  15. 15.

    Do you believe human albumin reduces frequency of delayed cerebral ischemia and vasospasm?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

  16. 16.

    Do you believe human albumin improves outcome in those patients experiencing delayed cerebral ischemia and vasospasm?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

  17. 17.

    How do you administer human albumin to SAH patients?

    1. a.

      IV bolus

    2. b.

      IV infusion

    3. c.

      Both

  18. 18.

    If you administer human albumin, do you believe that it benefits SAH patients?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

    4. d.

      Not applicable (I do not administer human albumin)

  19. 19.

    If you do not administer human albumin in SAH, please indicate the reason:

    1. a.

      It is a dangerous treatment

    2. b.

      I am convinced this treatment is futile

    3. c.

      I need more data from clinical trials showing efficacy

    4. d.

      Usage of human albumin is administratively restricted in my hospital

    5. e.

      Other (please state):_______________________________________

  20. 20.

    Do you believe that human albumin should not be administered in certain patients with SAH?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

  21. 21.

    If you answered yes to question 20, please indicate what type of patients should not be treated with human albumin:___________________________________

  22. 22.

    Whether or not you administer human albumin, do you believe that a clinical trial is needed to test the efficacy and safety of human albumin in SAH patients?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

  23. 23.

    In light of the neutral results of the ALIAS study (25 % Albumin In Ischemic Stroke) and the association of poor clinical outcome and 4 % albumin in TBI patients from the SAFE study (post hoc analysis), do you still believe that a clinical trial is needed to test the safety and efficacy of human albumin in SAH patients?

    1. a.

      Yes

    2. b.

      No

  24. 24.

    If your answer is Yes, please indicate the reason (select all that apply):

    1. a.

      SAH is a distinct disease

    2. b.

      Need to determine efficacy of currently used treatment

    3. c.

      Need to establish safety of this therapy

    4. d.

      The cost effectiveness of this therapy needs to be established for SAH

    5. e.

      The ALISAH pilot study* showed promising preliminary data

    6. f.

      Other (please state): _________________________________________

  25. 25.

    If your answer is No, please indicate the reason (select all that apply):

    1. a.

      We have sufficient evidence from other studies to extrapolate to SAH

    2. b.

      Human albumin is harmful

    3. c.

      Human albumin is too expensive

    4. d.

      I already believe that human albumin is effective in SAH

    5. e.

      Other (please state): _________________________________________

  26. 26.

    If a clinical trial is conducted to test the efficacy of 25 % human albumin in SAH as neuroprotectant compared to saline placebo, which absolute beneficial treatment effect threshold as determined by the Glasgow Outcome Scale will make you use this treatment in most SAH patients?

    1. a.

      5 %

    2. b.

      8 %

    3. c.

      10 %

    4. d.

      15 %

    5. e.

      20 %

    6. f.

      Other (please state): ________________________________________

  27. 27.

    If a clinical trial is conducted to test the efficacy of 25 % human albumin in SAH as neuroprotectant compared to saline placebo, would you like to see a positive effect in surrogate endpoints such as fewer infarcts on head imaging studies?

    1. a.

      Yes

    2. b.

      No

    3. c.

      Uncertain

Rights and permissions

Reprints and permissions

About this article

Cite this article

Suarez, J.I., Martin, R.H., Calvillo, E. et al. Human Albumin Administration in Subarachnoid Hemorrhage: Results of an International Survey. Neurocrit Care 20, 277–286 (2014). https://doi.org/10.1007/s12028-013-9942-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-013-9942-y

Keywords

Search

Navigation