Aneurysmal subarachnoid hemorrhage care in a middle-income public healthcare system: A real-world neurocritical care cohort.

Thire Baggio Machado Marazzi; Brunna Pileggi Rimoli; Ricardo Santos de Oliveira; Daniel Giansante Abud; Oct&#xe1;vio Marques Pontes-Neto

doi:10.1016/j.jocn.2026.112225

PubMed · 42556000

Aneurysmal subarachnoid hemorrhage care in a middle-income public healthcare system: A real-world neurocritical care cohort.

Thire Baggio Machado Marazzi·Brunna Pileggi Rimoli·Ricardo Santos de Oliveira·Daniel Giansante Abud·Octávio Marques Pontes-Neto

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Abstract

BACKGROUND AND PURPOSE: Although aneurysm treatment capacity has expanded worldwide, outcomes after aneurysmal subarachnoid hemorrhage (aSAH) remain strongly influenced by neurocritical care (NCC) delivery, referral pathways, and access to specialized treatment. Contemporary data describing real-world aSAH care in resource-limited healthcare systems remain scarce. We aimed to characterize treatment patterns, NCC delivery, complications, and outcomes in a large Brazilian public referral center. METHODS: This retrospective cohort study included consecutive adults with confirmed aSAH admitted between June 2018 and March 2022 to a high-volume Brazilian tertiary referral center. Only patients admitted within five days of symptom onset were included. Demographic, clinical, radiological, treatment, complication, and outcome data were extracted from institutional records. Primary outcomes were in-hospital mortality and 3-month functional outcome assessed by the modified Rankin Scale (mRS). RESULTS: Seventy-four patients were included. Disease severity was high, with 45% presenting WFNS grades 4-5, 73% modified Fisher grade 4 hemorrhage, and 64% hydrocephalus. Endovascular treatment was performed in 73% of cases, and median time from admission to aneurysm treatment was 1 day. Despite early treatment capability, only 28% of patients were admitted to an ICU within 48 h, while 38% never received ICU care. Delayed cerebral ischemia occurred in 43%, radiologic vasospasm in 58%, ventriculitis in 22%, and infectious complications in 57%. External ventricular drainage was required in 42%, and vasoactive drugs were used in 85%. In-hospital mortality was 42%, and 66% had unfavorable 3-month outcomes (mRS 4-6). CONCLUSIONS: This real-world cohort highlights the substantial neurocritical care burden of aSAH in a middle-income public healthcare system. Despite timely access to definitive aneurysm treatment, patients experienced frequent neurological and systemic complications, emphasizing that contemporary aSAH care extends well beyond aneurysm occlusion.

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Humans Subarachnoid Hemorrhage Female Retrospective Studies Male Middle Aged Critical Care Brazil Adult Cohort Studies Aged Hospital Mortality Endovascular Procedures Intracranial Aneurysm Treatment Outcome Developing countries Health systems Neurocritical care Journal Article

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Thire Baggio Machado Marazzi, Brunna Pileggi Rimoli, Ricardo Santos de Oliveira, Daniel Giansante Abud, Octávio Marques Pontes-Neto. 2026-08-05. Aneurysmal subarachnoid hemorrhage care in a middle-income public healthcare system: A real-world neurocritical care cohort.. https://doi.org/10.1016/j.jocn.2026.112225

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Journal Article resource Adult subject Aged subject Brazil subject Cohort Studies subject Critical Care subject Developing Countries subject Endovascular Procedures subject Female subject Hospital Mortality subject Humans subject Journal Article subject Male subject Middle Aged subject Neurocritical care subject

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