Emerging Therapeutics and Precision Critical Care in Aneurysmal Subarachnoid Hemorrhage

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is a serious neurological emergency that has a high rate of morbidity and mortality. The management of aSAH is still difficult despite improvements in neurocritical care, especially when it comes to avoiding and treating complications like cerebral vasospasm and delayed cerebral ischemia (DCI). This review examines new treatments and how precision critical care can help patients with aSAH achieve better results.Oral and intravenous nimodipine has been promising in the reduction of DCI and better neurological outcomes.  But the fluctuating outcomes of other medications, including clazosentan, fasudil and cilostazol make it necessary to conduct more research. Examples of precision critical care approaches that could be used to offer individualized treatment according to the needs of individual patients include advanced imaging, biomarker-guided care and multimodal neuromonitoring.  The approaches enable the anticipation of the risk of DCI, early identification of secondary brain injury, and optimization of the blood pressure and fluid balance. Some of the barriers to the implementation of precision critical care include patient variability, medical costs, the need to have certain infrastructure and knowledge.  Some of the ways in which AI-assisted tools, better imaging techniques, assessment tools to identify genetic risks and new biomarkers will be applied in the management of aSAH are the future directions.  In order to bridge the evidence to clinical practice gap and ensure that advanced therapies are available and affordable to a large group of patients, multicenter research programs and investments in healthcare are essential and scavenging incremental improvement of survival and long-term neurological recovery for aSAH patients is possible by adopting state-of-the-art technology and precision medicine approaches.