Outcomes of Pulse Index Continuous Cardiac Output Monitoring in Aneurysmal Subarachnoid Hemorrhage

Introduction: First introduced in 1997, the Pulse index Continuous Cardiac Output (PICCO) monitor has been implemented in critical illness to provide continuous measurement of parameters such as global end-diastolic index (i.e., preload,) systemic vascular resistance (i.e., afterload,) contractility, and extravascular volume. Our institution has utilized the monitoring device in critically ill aneurysmal subarachnoid hemorrhage (aSAH) patients in whom a detailed understanding of cardiac and volume-related parameters is required. In this study, we aimed to identify the patients in whom PICCO monitoring was utilized, and the complication profile of placing the monitor.

Methods: Adult patients who were treated for aSAH at our institution between 2009-2020 were included. Exclusion criteria were prior SAH, presentation over 48 hours after symptom onset, pre-treatment withdrawal, no aneurysm detected on computed tomography angiography, baseline modified Rankin Scale > 2, arteriovenous malformation-related, incidental, mycotic, or unruptured aneurysms. Univariate and multivariate analyses were conducted using simple logistic and linear regression methods. Primary outcomes included length of stay (LOS), mortality, post-hospitalization disposition, and whether a PICCO-related complication occurred.

Results: A total of 306 patients were included in the study. Of these, 27 (8.8%) patients underwent PICCO placement, with 6 (22.2%) experiencing complications. Patients with PICCO had a median LOS of 23 days, significantly longer than the 17 days for those without (p < 0.001). Discharge to non-home locations occurred in 19 (70.4%) of PICCO patients compared to 160 (57.3%) of non-PICCO patients, a non-significant difference. Mortality rates were 11.1% for PICCO patients and 6.8% for non-PICCO patients, a non-significant difference. Univariate and multivariate analysis, which controlled for Hunt Hess grade on presentation and vasospasm requiring treatment, revealed a significant association between PICCO usage duration and LOS (p = 0.025, p = 0.046, respectively), but not with non-home discharge, mortality, or PICCO complications.

Conclusion : Despite the insights offered by PICCO into cardiac and volume-related parameters, these findings suggest that PICCO monitoring might not add significant benefit to the outcomes of aSAH treatment. However, further study is warranted.