ABSTRACT NUMBER: ESOC2026A857 THE EFFECT OF INTRAVENOUS MANNITOL ON EARLY CLINICAL OUTCOME: RESULTS FROM THE MANNITOL FOR CEREBRAL OEDEMA AFTER INTRACEREBRAL HAEMORRHAGE FEASIBILITY TRIAL (MACE-ICH)

Abstract Background and aims Mannitol, an osmotic diuretic, might reduce cerebral oedema after acute intracerebral haemorrhage (ICH) but little is known on the early effects of treatment. We assessed these using data from the Mannitol for cerebral oedema after intracerebral haemorrhage trial (MACE-ICH). Methods 46 ICH participants with cerebral oedema or at risk presenting within 72 hours of ictus were recruited and randomised to 10% single dose mannitol; 10% mannitol repeated 24 hours later or standard care. The effect of mannitol on NIHSS at day 1, day 2 and death at day 28 was assessed. Results Baseline characteristics of participants were similar across the groups. At day 1, the mean NIHSS was 12.5 (S.D. 10.6) and there was no difference with treatment [mean difference, MD 0.80, (95% CI -1.62, 3.22)]. Similar results were observed with NIHSS at day 2. At day 28, death occurred in one participant randomised to two doses of mannitol, five allocated to single dose and two randomised to standard care (Odds Ratio, O.R. 0.48 95% CI (0.13, 1.83). Mannitol was not associated with excess number of adverse events. Conclusions MACE-ICH was feasible and treatment with mannitol seemed safe. A large trial is needed to assess efficacy. Conflict of interest MACE-ICH trial was funded by the National Institute for Health Research (NIHR), United Kingdom under the Research for Patient Benefit Programme (award ID: NIHR 203080).