Usage of mineralocorticoids and isotonic crystalloids in subarachnoid hemorrhage patients in the United States

Background: The usage rates of mineralocorticoids (fludrocortisone) to treat hyponatremia and isotonic crys-talloids (saline and balanced crystalloids) to maintain intravascular volume in patients with aneurysmal sub-arachnoid hemorrhage (aSAH) patients across the United States are unknown.Methods: We surveyed National Institute of Neurologic Disorders and Stroke (NINDS) StrokeNet sites in 2023, which are mostly large, tertiary, academic centers, and analyzed subarachnoid hemorrhage encounters from 2010 to 2020 in the Premier Healthcare Database that is representative of all types of hospitals and captures about 20 % of all acute inpatient care in the United States.Results: Although mineralocorticoids are used by 70 % of the NINDS StrokeNet sites, it is used in less than 20 % of the aSAH encounters in the Premier Database. Although saline is ubiquitously used, balanced crystalloids are increasingly used for fluid therapy in aSAH patients. Its use in the NINDS StrokeNet sites and the Premier Healthcare Database is 41 and 45 %, respectively.Conclusions: The use of mineralocorticoids remains low, and balanced crystalloids are increasingly used as fluid therapy in aSAH patients. The effectiveness of mineralocorticoids and balanced crystalloids in improving out-comes for aSAH patients must be rigorously tested in randomized clinical trials.