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External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purposes

External ventricular drainage (EVD) is frequently used to control raised intracranial pressure after traumatic brain injury. However, the available evidence about its effectiveness in this context is limited. The aim of this study is to evaluate the effectiveness of EVD to control intracranial pressure and to identify the clinical and radiological factors associated with its success.

Methods

For this retrospective cohort study conducted in a Level 1 traumacenter in Paris area between May 2011 and March 2019, all patients with intracranial hypertension and treated with EVD were included. EVD success was defined as an efficient and continuous control of intracranial hypertension avoiding the use of third tier therapies (therapeutic hypothermia, decompressive craniectomy, and barbiturate coma) or avoiding a decision to withdraw life sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions.

Results

83 patients with EVD were included. EVD was successful in 33 patients (40%). Thirty-two patients (39%) required a decompressive craniectomy, eight patients (9%) received barbiturate coma. In ten cases (12%) refractory intracranial hypertension prompted a protocolized withdrawal of care. Complications occurred in nine patients (11%) (three cases of ventriculitis, six cases of catheter occlusion). Multivariate analysis identified no independent factors associated with EVD success.

Conclusion

In a protocol-based management for traumatic brain injury, EVD allowed intracranial pressure control and avoided third tier therapeutic measures in 40% of cases with a favorable risk–benefit ratio.

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Availability of data and material

The data that support the findings of this study are available from a national registry but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request.

Abbreviations

TBI:

Traumatic brain injury

ICP:

Intracranial pressure

ICH:

Intracranial hypertension

EVD:

External ventricular drainage

CSF:

Cerebrospinal fluid

ISS:

Injury Severity Score

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP. Nord, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Jean-Denis Moyer, Saida Elouahmani, Anais Codorniu, Paer-Selim Abback, Caroline Jeantrelle, Tobias Gauss & Stéphanie Sigaut

  2. Department of Neurosurgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France

    Stéphane Goutagny

  3. Université de Paris, UFR de Médecine Paris Nord, Paris, France

    Stéphane Goutagny & Stéphanie Sigaut

  4. NeuroDiderot, Inserm U1141, Université de Paris, Paris, France

    Stéphanie Sigaut

Authors
  1. Jean-Denis Moyer
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  2. Saida Elouahmani
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Contributions

All authors have made substantial contributions to this work and have approved the final version of the manuscript. Data collection and quality control: all authors. Concept and design: JDM, AC, SE, SS statistical analysis: AC, SE. Interpretation of data: JDM, SE, AC, SS, SG, TG, PSA. Writing original draft: JDM, SE, AC, SG, TG, PSA, CJ. Writing review and editing: all authors.

Corresponding author

Correspondence to Jean-Denis Moyer.

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Conflict of interest

The authors declare that they have no known conflict of interest in relationship to this work.

Ethics approval

The TraumaBase group obtained approval for retrospective data use, from the Institutional Review Board (Comité de Protection des Personnes, Paris VI, Pitié, president Pr Laurent Lacapelle, Bâtiment de la Force, 47 Boulevard de lHôpital, 75,651 Paris Cedex 13, 28 November 2012) and from the Advisory Committee for Information Processing in Health Research (Comité consultatif sur le traitement de l’information en matière de recherche dans le domaine de la santé, authorisation 11.305bis) and from the National Commission for Data Protection (Commission Nationale de l’Informatique et des Libertés, authorisation 911,461).

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Cite this article

Moyer, JD., Elouahmani, S., Codorniu, A. et al. External ventricular drainage for intracranial hypertension after traumatic brain injury: is it really useful?. Eur J Trauma Emerg Surg 49, 1227–1234 (2023). https://doi.org/10.1007/s00068-022-01903-4

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  • DOI: https://doi.org/10.1007/s00068-022-01903-4

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