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Induced hypertension for preventing complications of delayed cerebral ischaemia in aneurysmal subarachnoid haemorrhage

Appendices

Appendix 1. MEDLINE search strategy

1. Subarachnoid Hemorrhage/

2. intracranial hemorrhages/ or cerebral hemorrhage/

3. Intracranial Aneurysm/

4. Rupture, Spontaneous/

5. 3 and 4

6. Aneurysm, Ruptured/

7. exp brain/ or exp meninges/

8. 6 and 7

9. ((subarachnoid or arachnoid) adj6 (haemorrhage$ or hemorrhage$ or bleed$ or blood$)).tw.

10. SAH.tw.

11. 1 or 2 or 5 or 8 or 9 or 10

12. Vasospasm, Intracranial/

13. ((cerebral or brain or intracranial or cerebrovascular) adj6 (vasospasm or spasm)).tw.

14. Ischemic Attack, Transient/ or brain ischemia/

15. (delay$ adj5 neurol$ adj5 deficit$).tw.

16. (DND or DIND).tw.

17. (delay$ adj5 (ischemi$ or ischaemi$)).tw.

18. or/12‐17

19. 11 or 18

20. hypertension/ci or intracranial hypertension/ or blood pressure/ or arterial pressure/

21. (triple H or triple‐H or HHH or hyperdynamic).tw.

22. ((increase$ or raise$) adj5 (blood or plasma or fluid) adj5 volume).tw.

23. ((increase$ or raise$ or maintain$) adj5 blood pressure).tw.

24. ((reduce$ or decreas$ or lower$) adj5 blood viscosity).tw.

25. (hypervolemi$ or hypervolaemi$ or (induc$ adj5 hypertension) or hypertensive or hemodilut$ or haemodilut$).tw.

26. blood volume/ or plasma volume/ or blood viscosity/

27. hemodilution/ or fluid therapy/

28. blood substitutes/ or plasma exchange/ or exp plasma substitutes/

29. hetastarch/ or dextrans/ or poly geline/ or povidone/ or exp albumins/ or sodium chloride/ or saline solution, hypertonic/ or expcolloids/

30. (hemodilut$ or haemodilut$).tw.

31. (plasma adj3 (expand$ or expansion or exchange$ or substitut$ or replace$)).tw.

32. (blood adj3 (expand$ or expansion or exchange$ or substitute$ or replace$ or remov$ or dilut$)).tw.

33. (hetastarch or pentastarch or hydroxyethy lstarch or hydroxyethyl‐starch or dextran$ or polygeline or povidone or albumin or salineor colloid$).tw.

34. VIH.tw.

35. or/20‐34

36. exp vasoconstrictor agents/ or calcium channel agonists/

37. vasopressins/ or arginine vasopressin/

38. ((vasoconstrict$ adj3 (agent$ or agonist$)) or vasopress$).tw.

39. (calcium channel adj3 (agonist$ or activat$)).tw.

40. exp angiotensins/

41. (angiotensin or arginine vasopressin or dihydroergotamine or ephedrine or epinephrine or ergotamine or etilefrine or felypressin or lypressin or mephentermine or metaraminol or methoxamine or methysergide or midodrine or nordefrin or norepinephrine or octopamine or ornipressin or phenylephrine or racepinephrine or sumatriptan or synephrine or vasopressins or vasotocin).tw.

42. exp Dopamine Agents/

43. (dopamin$ adj3 agonist$).tw.

44. (alnespirone or apomorphine or brexpiprazole or bromocriptine or cabergoline or cy 208‐243 or dihydrexidine or dihydroergocornine or dihydroergocryptine or dihydroergotamine or dihydroergotoxine or dironyl or docarpamine or dopexamine or ergocryptine or fananserin or fenoldopam or ibopamine or lisuride or mesulergine or metergoline or "n 0437" or naxagolide or ncq 298 or pd 158771 or pergolide or piribedil or pramipexole or preclamol or quinagolide or quinelorane or quinpirole or ropinirole or stepholidine or talipexole).tw.

45. exp Adrenergic Agonists/

46. exp Sympathomimetics/

47. sympathomimet$.tw.

48. (adrenerg$ adj3 agonist$).tw.

49. (albuterol or clenbuterol or clonidine or dexmedetomidine or dobutamine or epinephrine or ergotamine or etilefrine or fenoterol or formoterol fumarate or guanabenz or guanfacine or hexoprenaline or isoetharine or isoproterenol or isoxsuprine or medetomidine or mephentermine or metaproterenol or metaraminol or methoxamine or methyldopa or midodrine or naphazoline or nebivolol or norepinephrine or nylidrin or octopamine or oxyfedrine or oxymetazoline or phenylephrine or phenylpropanolamine or prenalterol or procaterol or racepinephrine or ritodrine or salmeterol xinafoate or synephrine or terbutaline or tretoquinol or xamoterol or xylazine).tw.

50. or/36‐49

51. 35 or 50

52. Randomized Controlled Trials as Topic/

53. Random Allocation/

54. Controlled Clinical Trials as Topic/

55. control groups/

56. clinical trials as topic/ or clinical trials, phase i as topic/ or clinical trials, phase ii as topic/ or clinical trials, phase iii as topic/ or clinical trials, phase iv as topic/

57. double‐blind method/

58. single‐blind method/

59. Placebos/

60. placebo effect/

61. cross‐over studies/

62. randomized controlled trial.pt.

63. controlled clinical trial.pt.

64. (clinical trial or clinical trial phase i or clinical trial phase ii or clinical trial phase iii or clinical trial phase iv).pt.

65. (random$ or RCT or RCTs).tw.

66. (controlled adj5 (trial$ or stud$)).tw.

67. (clinical$ adj5 trial$).tw.

68. ((control or treatment or experiment$ or intervention) adj5 (group$ or subject$ or patient$)).tw.

69. (quasi‐random$ or quasi random$ or pseudo‐random$ or pseudo random$).tw.

70. ((control or experiment$ or conservative) adj5 (treatment or therapy or procedure or manage$)).tw.

71. ((singl$ or doubl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).tw.

72. (cross‐over or cross over or crossover).tw.

73. (placebo$ or sham).tw.

74. trial.ti.

75. (assign$ or allocat$).tw.

76. controls.tw.

77. or/52‐76

78. 19 and 51 and 77

Table 1. 'Summary of findings' table template

Induced hypertension versus no induced hypertension in people with aneurysmal subarachnoid haemorrhage (SAH)

Participants: people with aneurysmal subarachnoid haemorrhage documented by CT scan, who underwent treatment of the aneurysm (either surgical clipping or intraluminal coiling) and entered the trial within 2 weeks after the SAH

Setting: hospital

Intervention: induced hypertension

Comparison: without induced hypertension

Outcomes

Absolute risk

Comparative risk (95% CI)

Relative effect (95% CI)

Number of participants

(studies)

Quality of the evidence

(GRADE)

Comments

Unfavourable outcome1 (90 days)

Death (any cause) at 90 days; in the intensive care unit; in hospital

Unfavourable outcome1 (6 months)

Incidence of DCI and vasospasm‐related complications within 3 weeks of the SAH

Cerebral infarction2

Re‐bleeding3

Complications of intervention4

Physiological outcome measures5

Abbreviations: CT scan: computed tomography scan; MRI scan: magnetic resonance imaging scan; SAH: subarachnoid haemorrhage; DCI: delayed cerebral ischaemia; CI: confidence interval; RR: risk ratio; GRADE: Grading of Recommendations Assessment, Development and Evaluation; MAP: mean arterial blood pressure.

1Unfavourable outcome: death, persistent vegetative state, or severe disability (modified Rankin Scale (mRS) score 4 to 6, Extended Glasgow Outcome Scale (GOSE) 4 to 6 or equivalent) at 90 days after SAH.
2Established cerebral infarction at any time within 90 days after SAH, confirmed radiologically by CT or MRI scan.
3Recurrent haemorrhage during the intervention or within 24 hours after the intervention.
4Complications of intervention, defined as a clinical deterioration observed during the intervention or within 24 hours after the intervention. These complications include arrhythmias, cardiac ischaemia, mesenteric ischaemia, digital ischaemia, and haemorrhagic stroke unrelated to the primary disease.
5Physiological outcome measures during the intervention or within 24 hours after the intervention. These include cerebral blood flow (CBF), cerebral perfusion pressure, cerebral tissue oxygenation, cerebral microdialysis, cardiac output and mean arterial blood pressure (MAP).

Figures and Tables -
Table 1. 'Summary of findings' table template