The present study is a randomized, multi-center, double-blind, prospective study that tests the efficacy of intravenous milrinone to optimize cerebral hemodynamic and prevent delayed cerebral ischemia (DCI) during the high-risk period (day 4- day 14) in patients with severe subarachnoid hemorrhage due to intracranial aneurysm rupture (SAHa) (WFNS IV-V). The main objective is to evaluate, in comatose patients and / or sedated on D3 following a severe SAHa (WFNS IV -V), the effect of 10 days of milrinone versus placebo, in addition to the usual management, on the volume of DCI lesions measured on CT scan at 1 month.
patients with severe SAHa (WFNS IV and V,) whose neurological examination is impossible because of coma (Glasgow coma score of 8 or less) or need for sedation at D3
absence of pre-existing neurological handicap (mRS 0-2)
major patient (≥ 18 years)
affiliation to social security or benefiting through a third person
patients with non-severe SAHa (WFNS I, II and III)
Occurrence of a major complication (haemorrhagic or ischaemic) documented during the procedure of securing the aneurysm and endangering the short-term vital prognosis
heart failure requiring inotropic administration at the time of randomization
ICHT at the time of randomisation (ICP> 25 mmHg for at least 20 min)
Parallel
Milrinone Injection
Drugadministration of milrinone (0.75 μg / kg / min, intravenous) from Day 4 to Day 14
Placebo
Other interventionadministration of placebo (intravenous glucose 5%) from Day 4 to Day 14
volume of delayed cerebral ischemia lesions
volume of DCI lesions measured on CT scan and validated by Magnetic Resonance Imaging (MRI) imaging at 1 month
Radiological parameters on CT at 1 month
percentage of patients with DCI lesions
Evolution in intensive care: Neurological complications 1
number of episodes of PtiO2 below the ischemic threshold in intensive care: PtiO2 \<20 mmHg (moderate hypoxia) and \<15 mm Hg (severe hypoxia) for at least 15 minutes
Evolution in intensive care: Neurological complications 2
total duration of episodes of PtiO2 \<20 mm Hg (moderate hypoxia) and \<15 mm Hg (severe hypoxia)
Evolution in intensive care: Neurological complications 3
number of recourse to an endovascular treatment
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