The evolving role of hemodilution in treatment of cerebral vasospasm: a historical perspective.

Abstract

Hypertension, hypervolemia, and hemodilution [HHH] therapy is widely used for prophylactic and therapeutic means in the setting of angiographic or clinical cerebral vasospasm. Hemodilution remains the most controversial aspect of the HHH therapy. We performed a literature review to identify the current state of support for hemodilution as a therapeutic modality in treatment of cerebral vasospasm. Over time, evidence has been accumulating against the efficacy of HHH therapy and hemodilution in particular. Although HHH therapy and consequently hemodilution has wide support, the evidence for its effectiveness remains equivocal. At the time of this study, the burden of evidence appears to be tipped away from hemodilution as a therapeutic modality.