As a consequence, patients admitted to nonspecialized centers need to be transferred to a referral hospital as soon as possible.

Definitive aneurysm treatment and ventricular drain, which is often necessary, can only be performed in a specialized center. Rapid aneurysm securing by endovascular or neurosurgical treatment is therefore essential.

In particular, aneurysmal rebleeding, occurring more frequently within the first 24 h after SAH, increases the risk of mortality and poor clinical outcome. After SAH, the main goal of neurocritical care is to prevent secondary brain injury. This transient global cerebral ischemia may have serious consequences. The sudden intracranial bleeding causes a dramatic increase of intracranial pressure (ICP), a drop of cerebral perfusion pressure (CPP), and a cerebral blood flow (CBF) reduction. Spontaneous aneurysmal subarachnoid hemorrhage (SAH), very often from the rupture of an intracranial aneurysm, is a neurological emergency associated with high morbidity and mortality worldwide. Our recommendations cover most, but not all, topics of clinical relevance. Clinical advice, based on multidisciplinary consensus, might be helpful. Management of SAH in a non-specialized setting and early transfer are difficult and may have a critical impact on outcome. In one case, where consensus could not be agreed upon, no recommendation could be provided. Consensus was reached on 11 strong recommendations and 2 weak recommendations. ResultsДЄ total of 14 statements have been discussed. MethodsДЄ multidisciplinary consensus panel composed by 19 physicians selected for their established clinical and scientific expertise in the acute management of SAH patients with different specializations (anesthesia/intensive care, neurosurgery and interventional neuroradiology) was created. To address these issues, we created a consensus of experts endorsed by the Italian Society of Anesthesia and Intensive Care (SIAARTI) to provide clinical guidance. The immediate management of subarachnoid hemorrhage (SAH) patients in hospitals without neurosurgical/neurointerventional facilities and their transfer to a specialized center is challenging and not well covered in existing guidelines.

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