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

Neurosurg Rev. 2022 Feb;45(1):365-373. doi: 10.1007/s10143-021-01627-w. Epub 2021 Aug 26.

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.

Keywords: Cerebrospinal fluid drainage; External ventricular drain; Hydrocephalus; Subarachnoid haemorrhage; Ventriculostomy.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Drainage
  • Humans
  • Hydrocephalus* / surgery
  • Neurosurgical Procedures
  • Subarachnoid Hemorrhage* / complications
  • Subarachnoid Hemorrhage* / surgery
  • Ventriculostomy