Introduction: External ventricular drains (EVD) are often employed in patients with primary intraventricular hemorrhage (IVH) or intra-ventricular extension (IVE) of intracerebral hemorrhage (ICH) as therapy to promote clearance of the blood products. However, little data exists on the rate of IVH clearance in these patients.
Methods: All patients admitted to the Neurological ICU at Columbia University Medical Center with primary IVH or IVE following ICH between December 2009 and July 2011 were screened and enrolled in our prospective ICH database. Demographic, clinical, and radiographic data were collected during admission. Volumetric analysis for imaging was performed by an experienced observer using MIPAV volumetric software. We assumed a steady IVH clearance rate through the EVD to facilitate analysis.
Results: During the study time, 151 patients were enrolled into our database. Of the 43 patients with IVH/ICH and an EVD in place, 6 were excluded due to intrathecal thrombolytics administration, and 16 were excluded due to insufficient radiographic imaging, for a total cohort of 21 patients. The EVDs placed were antibiotic-impregnated and had a small lumen (internal diameter of 1.3mm). Mean age was 57.7 years, and 15 were male (71.4%). On admission imaging, mean ICH volume was 29.9 + 28.6 cm3, and mean IVH volume was 12.46 + 10.7 cm3. EVDs were placed within 2 days of admission for 90.5% of patients, and within 4 days for the remaining 2 patients. The overall mean rate of IVH clearance was 0.22 ml/hr, though it was increased in the first 12 hours after placement, with an early mean of 0.63 ml/hr. Over an average of 3 days, the mean IVH volume decreased from a pre-EVD baseline of 16.8 cm3 to 8.5 cm3. Duration of EVD therapy ranged from less than one day up to two weeks. Three patients developed ventriculitis (14.2%) during their admission.
Conclusions: Small-lumen EVDs are a valuable therapeutic option for IVH clearance in this patient population. The rate of hemorrhage clearance is increased in the first 12 hours following EVD placement relative to the overall rate of clearance. Drainage of blood products through an EVD should be considered for patients with clinically significant IVH.
Patient Care: By becoming familiar with the rate of drainage of external ventricular drains and their benefit as a therapeutic option for intraventricular hemorrhage, physicians may be able to better select and treat these patients, minizming complications from intraventricular hemorrhage and maximizing outcomes after this severe neurological injury.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the role of external ventricular drains in intraventricular hemorrhage 2) Describe the temporal effect of external ventricular drains on the drainage of blood products from the ventricular system 3) Identify patients that may benefit from this treatment