Evidence map›Paper›PMID 33205356›Full record

ArticleNeurocritical care2021

Hemorrhagic Complications of Invasive Intracranial Pressure Monitor Placement in Acute Liver Failure: Outcomes of a Single-Center Protocol and Comprehensive Literature Review.

Sayuri P Jinadasa, Qing Zhao Ruan, Ahmed B Bayoumi, Sunjay V Sharma, M Dustin Boone, Raza Malik, Clark C Chen, Ekkehard M Kasper

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Article in Neurocritical care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 23 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 2 countries.

Sayuri P JinadasaDepartment of General Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.ORCID http://orcid.org/0000-0002-4144-1174
Qing Zhao RuanDepartment of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Ahmed B BayoumiDivision of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada.
Sunjay V SharmaDivision of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada.
M Dustin BooneDepartment of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Raza MalikDepartment of Gastroenterology, Tufts Medical Center, Boston, MA, USA.
Clark C ChenDepartment of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
Ekkehard M KasperDivision of Neurosurgery, McMaster University/Hamilton Health Sciences, 237, Barton Street East, Hamilton, ON, L8L 2X2, Canada. kaspere@mcmaster.ca.
Hamilton Health Sciences · CABeth Israel Deaconess Medical Center · USDartmouth–Hitchcock Medical Center · USTufts Medical Center · USUniversity of Minnesota · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElevated intracranial pressure due to cerebral edema is associated with very poor survival in patients with acute liver failure (ALF). Placing an intracranial pressure monitor (ICPm) aids in management of intracranial hypertension, but is associated with potentially fatal hemorrhagic complications related to the severe coagulopathy associated with ALF.

methodsAn institutional Acute Liver Failure Clinical Protocol (ALF-CP) was created to correct ALF coagulopathy prior to placing parenchymal ICP monitoring bolts. We aimed to investigate the frequency, severity, and clinical significance of hemorrhagic complications associated with ICPm bolt placement in the setting of an ALF-CP. All assessed patients were managed with the ALF-CP and had rigorous radiologic follow-up allowing assessment of the occurrence and chronology of hemorrhagic complications. We also aimed to compare our outcomes to other studies that were identified through a comprehensive review of the literature.

resultsFourteen ALF patients were included in our analysis. There was no symptomatic hemorrhage after ICP monitor placement though four patients were found to have minor intraparenchymal asymptomatic hemorrhages after liver transplant when the ICP monitor had been removed, making the rate of radiographically identified clinically asymptomatic hemorrhage 28.6%. These results compare favorably to those found in a comprehensive review of the literature which revealed rates as high as 17.5% for symptomatic hemorrhages and 30.4% for asymptomatic hemorrhage.

conclusionThis study suggests that an intraparenchymal ICPm can be placed safely in tertiary referral centers which utilize a protocol such as the ALF-CP that aggressively corrects coagulopathy. The ALF-CP led to advantageous outcomes for ICPm placement with a 0% rate of symptomatic and low rate of asymptomatic hemorrhagic complications, which compares well to results reported in other series. A strict ICPm placement protocol in this setting facilitates management of ALF patients with cerebral edema during the wait time to transplantation or spontaneous recovery.

Indexed as

Brain EdemaIntracranial HypertensionLiver Failure, AcuteHumansIntracranial PressureMonitoring, PhysiologicReview Literature as TopicCoagulopathyFactor VIIaIntracranial monitoringLiver failureLiver transplantation

Identifiers

PMID33205356
OpenAlexW3100484359

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.