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The Aalborg Bolt-Connected Drain (ABCD) study: a prospective comparison of tunnelled and bolt-connected external
Sofia Kamakh Asaad1, Carsten Reidies Bjarkam2
1Department of Neurosurgery, Institute of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark. s.asaad@rn.dk.
Insights
Bolt-connected external ventricular drainage (BC-EVD) significantly reduces complications compared to traditional tunnelled EVD (T-EVD). BC-EVD should be the preferred method for EVD placement due to its lower complication rates.
Area of Science:
- Neurosurgery
- Medical Devices
- Patient Safety
Background:
- Acutely increased intracranial pressure (ICP) management often involves external ventricular drainage (EVD).
- Standard tunnelled EVD (T-EVD) carries a high complication rate.
- Bolt-connected EVD (BC-EVD) is a newer technique proposed to reduce complications.
Purpose of the Study:
- To prospectively compare complication rates between BC-EVD and T-EVD.
- To evaluate the efficacy of BC-EVD in reducing adverse events associated with EVD placement.
Main Methods:
- Prospective cohort study comparing BC-EVD and T-EVD over 12 months.
- Neurosurgical decision-making determined EVD type allocation.
- Complications including CSF leakage, infection, and hemorrhage were systematically recorded.
Main Results:
- Fewer complications were observed in the BC-EVD group (17.6%) compared to the T-EVD group (59.4%).
- The relative risk of complications with T-EVD was 3.4 times higher than with BC-EVD (p=0.007).
Conclusions:
- BC-EVD is associated with a significantly lower incidence and risk of complications than T-EVD.
- BC-EVD should be considered the primary choice for EVD placement.
- T-EVD retains a role for specific applications, such as in pediatric patients or intraoperative/occipital placements.
Background:
Acutely increased intracranial pressure (ICP) is frequently managed by external ventricular drainage (EVD). This procedure is life-saving but marred by a high incidence of complications. It has recently been indicated that bolt-connected external ventricular drainage (BC-EVD) compared to the standard technique of tunnelled EVD (T-EVD) may result in less complications.
Aim:
To prospectively sample and compare two cohorts by consecutive allocation to either BC-EVD or T-EVD from the introduction of the BC-EVD technique in our department and 12 months onward.
Methods:
Patients undergoing ventriculostomy between the 1st of March 2017 and the 28th of February 2018 were considered for inclusion. The neurosurgeon on-call sovereignly set the indication and decided on EVD type (BC-EVD or T-EVD), consequently resulting in two cohorts as 3/7 senior neurosurgeons on call were open to the use of BC-EVD, while 4/7 were reluctant to use this technique. Data was continuously collected using patient records, including results of cerebrospinal fluid (CSF) culturing and available CT/MRI-scans. Recorded complications included CSF leakage, accidental discontinuation, placement-related intracranial haemorrhage, malfunction, migration, infection and revision.
Results:
Forty-nine EVDs (32 T-EVDs/17 BC-EVDs) were included; 19/32 (59.4%) T-EVDs and 3/17 (17.6%) BC-EVDs were found to have complications (p = 0.007). The relative risk of complications when using T-EVD was 3.4 times that of BC-EVD.
Conclusion:
Ventriculostomy by BC-EVD compared to T-EVD reduces incidence and risk of complications and should be the first choice in EVD placement. That said, T-EVD has a role in paediatric patients and for intraoperatively and occipitally placed EVDs.
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