Neurocritical Care

, Volume 16, Issue 3, pp 399–405

Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage

Authors

    • Division of Neurosciences Critical CareJohns Hopkins University School of Medicine
  • Eric Melnychuk
    • Division of Brain Injury Outcomes, Department of NeurologyJohns Hopkins University School of Medicine
  • John Muschelli
    • Division of Brain Injury Outcomes, Department of NeurologyJohns Hopkins University School of Medicine
  • Daniel F. Hanley
    • Division of Brain Injury Outcomes, Department of NeurologyJohns Hopkins University School of Medicine
  • Issam A. Awad
    • Section of NeurosurgeryUniversity of Chicago Medical Center
  • Wendy C. Ziai
    • Division of Neurosciences Critical CareJohns Hopkins University School of Medicine
Original Article

DOI: 10.1007/s12028-011-9569-9

Cite this article as:
Hinson, H.E., Melnychuk, E., Muschelli, J. et al. Neurocrit Care (2012) 16: 399. doi:10.1007/s12028-011-9569-9

Abstract

Background

Little is known about the efficacy of single versus dual extraventricular drain (EVD) use in intraventricular hemorrhage (IVH), with and without thrombolytic therapy.

Methods

Post-hoc analysis of seven patients with dual bilateral EVDs from two multicenter trials involving 100 patients with IVH, and spontaneous intracerebral hemorrhage (ICH) volume <30 ml requiring emergency external ventricular drainage. Seven “control” patients with single catheters were matched by IVH volume and distribution and treatment assignment. Head CT scans were obtained daily during intraventricular injections for quantitative determination of IVH volume.

Results

Median [min–max] age of the 14 subjects was 56 [40–73] years. Median duration of EVD was 7.9 days (single catheter group) versus 12.2 days (dual catheter group) (P = 0.34). Baseline median IVH volume was not significantly different between groups (75.4 ml [22.4–105.1]—single EVD vs. 84.5 ml [42.0–132.0]—dual EVD; P = 0.28). Comparing the change in IVH volume on time-matched CT scans during dual EVD use, the median decrease in IVH volume in dual catheter patients was significantly larger (52.1 [31.7–81.1] ml) versus single catheter patients (34.5 [13.1–73.9] ml) (P = 0.004). There was a trend to greater decrease in IVH volume during dual EVD use in both rt-PA (P = 0.9) and placebo-treated (P = 0.11) subgroups.

Conclusion

The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy.

Keywords

External ventricular drain Intraventricular hemorrhage Thrombolysis

Copyright information

© Springer Science+Business Media, LLC 2011