Neurocritical Care

, Volume 16, Issue 3, pp 399–405 | Cite as

Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage

  • Holly E. Hinson
  • Eric Melnychuk
  • John Muschelli
  • Daniel F. Hanley
  • Issam A. Awad
  • Wendy C. Ziai
Original Article

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 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Holly E. Hinson
    • 1
  • Eric Melnychuk
    • 2
  • John Muschelli
    • 2
  • Daniel F. Hanley
    • 2
  • Issam A. Awad
    • 3
  • Wendy C. Ziai
    • 1
  1. 1.Division of Neurosciences Critical CareJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of Brain Injury Outcomes, Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Section of NeurosurgeryUniversity of Chicago Medical CenterChicagoUSA

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