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External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis

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A Letter to the editor to this article was published on 23 January 2022

Abstract

External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. Despite this, the optimal drainage and weaning strategies are still unknown. This PRISMA-compliant systematic review and meta-analysis analysed the outcomes of patients undergoing EVD procedures, comparing continuous versus intermittent drainage and rapid versus gradual weaning. Four databases were searched from inception to 01/10/2020. Articles reporting at least 10 patients treated for hydrocephalus secondary to subarachnoid haemorrhage were included. Other inclusion criteria were the description of the EVD drainage and weaning strategies used and a comparison of continuous versus intermittent drainage or rapid versus gradual weaning within the study. Random effect meta-analyses were used to compare functional outcomes, incidence of complications and hospital length of stay. Intermittent external CSF drainage was associated with lower incidence of EVD-related infections (RR = 0.20, 95% CI 0.05–0.72, I-squared = 0%) and EVD blockages compared to continuous CSF drainage (RR = 0.45, 95% CI 0.27–0.74, I-squared = 0%). There was no clear advantage in using gradual EVD weaning strategies compared to rapid EVD weaning; however, patients who underwent rapid EVD weaning had a shorter hospital length of stay (SMD = 0.34, 95% CI 0.22–0.47, I-squared = 0%). Intermittent external CSF drainage after SAH is associated with lower incidence of EVD-related infections and EVD blockages compared to continuous CSF drainage. Patients who underwent rapid EVD weaning had a shorter hospital length of stay and there was no clear clinical advantage in using gradual weaning.

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Availability of data and material

Data for the primary analyses presented in this report are available on request from any qualified investigator for purposes of replicating the results.

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Author notes

  1. Joanna Palasz and Linda D’Antona contributed equally to this work.

Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, Box 32, London, WC1N 3BG, UK

    Joanna Palasz, Linda D’Antona, Sarah Farrell, Mohamed A. Elborady, Laurence D. Watkins & Ahmed K. Toma

  2. UCL Queen Square Institute of Neurology, London, UK

    Linda D’Antona, Laurence D. Watkins & Ahmed K. Toma

  3. Royal Free Hospital, Pond St, Hampstead, London, UK

    Sarah Farrell

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Contributions

JP and AKT designed and conceptualised the study. JP, LD and SF acquired the data. JP and LD analysed the data and drafted the manuscript. All the authors interpreted the results and revised the manuscript.

Corresponding author

Correspondence to Joanna Palasz.

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Competing interests

LD is supported by an NIHR Academic Clinical Fellowship and was the recipient of a research fellowship sponsored by B. Braun. LDW has received honoraria from and served on advisory boards for Medtronic, B. Braun and Codman. AKT research time was supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. The other authors have no disclosures to report.

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Palasz, J., D’Antona, L., Farrell, S. et al. External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis. Neurosurg Rev 45, 365–373 (2022). https://doi.org/10.1007/s10143-021-01627-w

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