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Published on: May 26, 2015
Ventricular catheter location and the clearance of intraventricular hemorrhage
Jennifer Jaffe1, Eric Melnychuk, John Muschelli
1University of Chicago Pritzker School of Medicine, Section of Neurosurgery, Chicago, Illinois 60637, USA.
Insights
External ventricular drain (EVD) placement may be optimized with thrombolytic agents to improve intraventricular hemorrhage (IVH) clearance. Laterality showed a trend toward faster clearance when EVD was on the side with more blood.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Optimal external ventricular drain (EVD) placement for intraventricular hemorrhage (IVH) clearance lacks consensus.
- Investigating EVD laterality's impact on IVH resolution is crucial for treatment optimization.
Purpose of the Study:
- To test if EVD laterality influences intraventricular hemorrhage (IVH) clearance.
- To evaluate this influence with and without thrombolytic agent administration.
Main Methods:
- Analysis of 100 patients from CLEAR IVH phase II trials.
- Correlation of external ventricular drain (EVD) catheter laterality with intraventricular hemorrhage (IVH) clearance rates.
- Assessment of thrombolysis safety and dose optimization for IVH clearance.
Main Results:
- Thrombolytic administration significantly improved IVH clearance over 3 days compared to placebo, irrespective of EVD laterality.
- A trend suggested faster total IVH clearance with thrombolysis when EVD was ipsilateral to the dominant hemorrhage side (P=.09).
- EVD laterality did not affect clearance of blood in the third and fourth ventricles.
Conclusions:
- External ventricular drain (EVD) placement may be optimized using lytic agents to enhance total IVH clearance.
- EVD laterality might influence total IVH clearance when thrombolytics are used.
- EVDs placed on either side effectively clear the third and fourth ventricles.
Background:
There is no consensus regarding optimal position of an external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH).
Objective:
To assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system with and without administration of thrombolytic agent.
Methods:
The EVD location was assessed in 100 patients in 2 Clot Lysis Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR IVH) phase II trials assessing the safety and dose optimization of thrombolysis through the EVD to accelerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates.
Results:
Clearance of IVH over the first 3 days was significantly greater when thrombolytic compared with placebo was administered regardless of catheter laterality (P < .005; 95% confidence interval, -14.0 to -4.14 for contralateral EVD and -24.7 to -5.44 for ipsilateral EVD). When thrombolytic was administered, there was a trend toward more rapid clearance of total IVH through an EVD placed on the side of dominant intraventricular blood compared with an EVD on the side with less blood (P = .09; 95% confidence interval, -9.62 to 0.69). This was not true when placebo was administered. Clearance of third and fourth ventricular blood was unrelated to EVD laterality.
Conclusion:
It is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the third and fourth ventricles with equal efficiency.
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