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Evidence-Based Management of External Ventricular Drains

  • Critical Care (Stephan A. Mayer, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The optimal management of external ventricular drains (EVD) in the setting of acute brain injury remains controversial. Therefore, we sought to determine whether there are optimal management approaches based on the current evidence.

Recent Findings

We identified 2 recent retrospective studies on the management of EVDs after subarachnoid hemorrhage (SAH) which showed conflicting results. A multicenter survey revealed discordance between existing evidence from randomized trials and actual practice. A prospective study in a post-traumatic brain injury (TBI) population demonstrated the benefit of EVDs but did not determine the optimal management of the EVD itself. The recent CLEAR trials have suggested that specific positioning of the EVD in the setting of intracerebral hemorrhage with intraventricular hemorrhage may be a promising approach to improve blood clearance.

Summary

Evidence on the optimal management of EVDs remains limited. Additional multicenter prospective studies are critically needed to guide approaches to the management of the EVD.

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Acknowledgments

The authors would like to thank Anna Cervantes-Arslanian, MD, for helpful comments.

Funding

This work was supported by the National Institutes of Health (R25NS065743, KL2TR002542, and K08NS112601); the American Heart Association and American Stroke Association (18POST34030369); the Andrew David Heitman Foundation; the Aneurysm and AVM Foundation; and the Brain Aneurysm Foundation’s Timothy P. Susco and Andrew David Heitman Foundation Chairs of Research.

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Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA

    David Y. Chung & Guy A. Rordorf

  2. Department of Neurology, Boston Medical Center, Boston, MA, USA

    David Y. Chung

  3. Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    DaiWai M. Olson

  4. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

    Sayona John

  5. Department of Neurology, Wayne State University, Detroit, MI, USA

    Wazim Mohamed

  6. Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Monisha A. Kumar

  7. Departments of Neurology and Neurosurgery, Warren Alpert Medical School, Brown University, Providence, RI, USA

    Bradford B. Thompson

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  1. David Y. Chung
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Correspondence to David Y. Chung.

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Conflict of Interest

David Y. Chung, Sayona John, Wazim Mohamed, Monisha A. Kumar, and Guy A. Rordorf each declare no potential conflicts of interest. DaiWai M. Olson is the Editor in Chief, Journal of Neuroscience Nursing. Bradford B. Thompson reports Investigator Meeting travel-related reimbursements from BARD.

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Chung, D.Y., Olson, D.M., John, S. et al. Evidence-Based Management of External Ventricular Drains. Curr Neurol Neurosci Rep 19, 94 (2019). https://doi.org/10.1007/s11910-019-1009-9

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