Neurology in critical care · Preventing delayed ischaemia after subarachnoid haemorrhage
British aneurysm nimodipine trial
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Oral nimodipine 60 mg four-hourly |
| Control | Placebo |
| Population | 554 patients with subarachnoid haemorrhage |
| Follow-up | 3 months |
| Primary endpoint | Cerebral infarction and poor outcome |
| Result | Cerebral infarction occurred in 61 of 278 (22%) on nimodipine versus 92 of 276 (33%) on placebo — a 34% relative reduction (95% CI 13 to 50). Poor outcomes fell by 40% (95% CI 20 to 55): 55 of 278 (20%) versus 91 of 278 (33%). |
| Secondary endpoints | Mortality, disability, tolerability |
Oral nimodipine 60 mg four hourly is well tolerated and reduces cerebral infarction snd improves outcome after subarachnoid haemorrhage.
The trial authors, in the published abstract
Nearly forty years on, nimodipine remains the only drug that improves outcome in subarachnoid haemorrhage, and it is still given on the strength of this trial. Remarkable durability for a single result, and an uncomfortable reminder of how little has been added since.
Pickard JD, Murray GD, Illingworth R, et al. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ 1989 Mar 11;298(6674):636-42.