Safety and efficacy of magnesium-rich artificial cerebrospinal fluid for subarachnoid hemorrhage

Yawen Cheng; Xiangning Han; Wanfu Xie; Gaofeng Xu; Xiaobin Bai; Lei Qi; Linjuan Zhang; Rui Liu; Weihua Dong; Weiyi Feng; Chengsen Pang; Wei Zhang; Fude Liu; Xiangqi Cao; Yue Xu; Guogang Luo

doi:10.3389/fneur.2024.1376216

Safety and efficacy of magnesium-rich artificial cerebrospinal fluid for subarachnoid hemorrhage

Front Neurol. 2024 Mar 28:15:1376216. doi: 10.3389/fneur.2024.1376216. eCollection 2024.

Authors

Yawen Cheng^#¹, Xiangning Han^#¹, Wanfu Xie², Gaofeng Xu², Xiaobin Bai², Lei Qi², Linjuan Zhang³, Rui Liu¹, Weihua Dong⁴, Weiyi Feng⁴, Chengsen Pang⁴, Wei Zhang², Fude Liu¹, Xiangqi Cao¹, Yue Xu¹, Guogang Luo¹

Affiliations

¹ Department of Neurology and Stroke Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
² Department of Neurosurgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
³ Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
⁴ Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

^# Contributed equally.

Abstract

Objectives: This study aimed to investigate the efficacy of using a newly formulated magnesium-rich artificial cerebrospinal fluid (MACSF) as an alternative to normal saline (NS) for intraoperative irrigation during aneurysm clipping in improving the prognosis of patients with Aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Patients with aSAH who underwent intraoperative irrigation with MACSF or NS during the clipping in the First Affiliated Hospital of Xi 'an Jiaotong University from March 2019 to March 2022 were selected as MACSF group and NS group, respectively. The primary prognostic indicators were the incidence of favorable outcomes (mRS 0-2). The secondary outcome measures included cerebral vasospasm (CVS), mortality, total hospital stay, and intensive care unit (ICU) stay. Safety was evaluated based on the occurrence rates of hypermagnesemia, meningitis, and hydrocephalus.

Results: Overall, 34 and 37 patients were enrolled in the MACSF and NS groups, respectively. At 90 days after aSAH onset, the proportion of favorable prognosis in the MACSF group was significantly higher than that in the NS group (p = 0.035). The incidence of CVS within 14 days after surgery was significantly lower in the MACSF group than that in the NS group (p = 0.026). The mortality rate in the MACSF group was significantly lower than in the NS group (p = 0.048). The median lengths of hospital stay (p = 0.008) and ICU stay (p = 0.018) were significantly shorter in the MACSF group than in the NS group. No significant differences were observed in safety measures.

Conclusion: Using MACSF as an irrigation fluid for aneurysm clipping can significantly improve the 90-day prognosis of patients with aSAH, which may be related to the reduced incidence of CVS.

Clinical trial registration: https://www.clinicaltrials.gov, identifier NCT04358445.

Keywords: aneurysmal subarachnoid hemorrhage; artificial cerebrospinal fluid; cerebral vasospasm; magnesium; prognosis.

Associated data

ClinicalTrials.gov/NCT04358445

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by grants from the clinical research center of the First Affiliated Hospital of Xi’an Jiaotong University (grant no. XJTU1AF-CRF-2020-015 and no. 2021ZYTS-03).