Inhibition of Delayed Cerebral Ischemia by Magnesium Is Insufficient for Subarachnoid Hemorrhage Patients: A Network Meta-Analysis.

Objective: After subarachnoid hemorrhage, magnesium could reduce the incidence of delayed cerebral ischemia; however, it is still controversial. This study updated the results of recently published magnesium-related studies and conducted an exploratory analysis of the impact of application strategies and intervention factors on the results.

Methods: Public databases were searched from the date of their inception to May 10, 2021. Randomized controlled trials on magnesium agent-related regimens for subarachnoid hemorrhage patients were included.

Results: In total, 28 articles were included in the meta-analysis. For delayed cerebral ischemia, magnesium-related interventions significantly reduced the risk of delayed cerebral ischemia compared with nonmagnesium interventions (odds ratios: 0.40; 95% confidence interval: 0.28-0.56; < 0.01). For cerebral vasospasm, a random effects model showed that magnesium significantly reduced the risk of cerebral vasospasm (odds ratios: 0.46; 95% confidence interval: 0.33-0.63; < 0.01). In the subgroup analysis, intracranial magnesium (odds ratios: 6.67; 95% confidence interval: 1.14-38.83; =0.03) and magnesium plus hydrogen (odds ratios: 10; 95% confidence interval: 1.59-62.73; =0.01) produced significant results in improving the good recovery rate compared to the control. In the network meta-analysis, magnesium plus nimodipine and simvastatin even showed an effective trend in death/persistent vegetative status improvement.

Conclusion: This study supports the beneficial effect of magnesium in reducing the risk of delayed cerebral ischemia. Based on a single randomized controlled trial, immediate intracranial magnesium therapy with intravenous hydrogen after subarachnoid hemorrhage can increase the good recovery rate. Therefore, more high-quality studies are needed to confirm this finding.