Mendelow, A.D., et al (2005) “Early surgery versus initial conservative treatment in patient with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral haemorrhage (STICH): a randomised trial” Lancet 365:387-397 [PMID 15680453]
- n = 1033 with acute supratentorial intracerebral haemorrhage
- early haematoma evacuation + medical treatment VS conservative treatment with delayed surgery if required
- exclusion criteria: suspected aneurysms or AVM and haemorrhages extending into brainstem/cerebellum
-> no difference in outcome @ 6 months
-> haematoma near cortex -> did better with decompression
-> haematoma not near cortex -> do badly with decompression
-> study criticized because surgical technique was not standardised, some patients in ‘early’ intervention not operated on for 12 hours.
Molyneux, A.J. et al (2002) “International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups and aneurysm occlusion.” Lancet 366:809-817 [PMID 16139655]
- n = 2413
- comparison of clipping vs coiling when both treatments were appropriate (small aneurysms + anterior circulation)
- coiling produced:
-> more independent survivors @ 1 year -> continues to 7 years.
-> slightly increase risk of re-bleeding
Pickard, J.D., et al (1989) “Effects of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British Aneurysm Nimodipine Trial” BMJ 298:636-642 [PMC1835889]
- n = 554
- oral nimodpine (60mg Q4hrly for 21 days) vs placebo
-> reduce incidence of cerebral infarction
-> reduce poor neurological outcome @ 3 months
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.