Skip to main content

Advertisement

SpringerLink
Log in

Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Vereecken KK, Van Havenbergh T, De Beuckelaar W, Parizel PM, Jorens PG. Treatment of intraventricular hemorrhage with intraventricular administration of recombinant tissue plasminogen activator. A clinical study of 18 cases. Clin Neurol Neurosurg. 2006;108(5):451–5.

    Article  PubMed  Google Scholar 

  2. Coplin WM, Vinas FC, Agris JM, et al. A cohort study of the safety and feasibility of intraventricular urokinase for nonaneurysmal spontaneous intraventricular hemorrhage. Stroke. 1998;29(8):1573–9.

    Article  PubMed  CAS  Google Scholar 

  3. Findlay JM, Grace MG, Weir BK. Treatment of intraventricular hemorrhage with tissue plasminogen activator. Neurosurgery. 1993;32(6):941–7. (discussion 947).

    Article  PubMed  CAS  Google Scholar 

  4. Andrews CO, Engelhard HH. Fibrinolytic therapy in intraventricular hemorrhage. Ann Pharmacother. 2001;35(11):1435–48.

    Article  PubMed  CAS  Google Scholar 

  5. Naff NJ, Carhuapoma JR, Williams MA, et al. Treatment of intraventricular hemorrhage with urokinase : effects on 30-Day survival. Stroke. 2000;31(4):841–7.

    Article  PubMed  CAS  Google Scholar 

  6. Staykov D, Huttner HB, Lunkenheimer J, et al. Single versus bilateral external ventricular drainage for intraventricular fibrinolysis in severe ventricular haemorrhage. J Neurol Neurosurg Psychiatry. 2010;81(1):105–8.

    Article  PubMed  CAS  Google Scholar 

  7. Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.

    Article  PubMed  CAS  Google Scholar 

  8. Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology. 1982;143(1):91–6.

    PubMed  CAS  Google Scholar 

  9. Pang D, Sclabassi RJ, Horton JA. Lysis of intraventricular blood clot with urokinase in a canine model: Part 1. Canine intraventricular blood cast model. Neurosurgery. 1986;19(4):540–6.

    Article  PubMed  CAS  Google Scholar 

  10. Mayfrank L, Kissler J, Raoofi R, et al. Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke. 1997;28(1):141–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

CLEAR IVH is sponsored by the FDA orphan drug program, assisted by a donation from Cathflo and a sponsored research agreement with Genentech. Use Patent holder: Johns Hopkins Medical Institutions. Drs. Hanley and Naff hold an Investigator IND for the use of intracerebral rt-PA.

Conflict of interest

Dr. Hinson, Mr. Melnychuk, and Mr. Muschelli have nothing to disclose. Dr. Hanley has received research support as PI of the CLEAR IVH trial, which is sponsored by the FDA Orphan Drug Program assisted by a donation from Cathflo and a sponsored research agreement from Genentech. Dr. Ziai has received personal compensation in an editorial capacity for Current Opinion in Neurology.

Author information

Authors and Affiliations

  1. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USA

    Holly E. Hinson & Wendy C. Ziai

  2. Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Eric Melnychuk, John Muschelli & Daniel F. Hanley

  3. Section of Neurosurgery, University of Chicago Medical Center, Chicago, IL, USA

    Issam A. Awad

Authors
  1. Holly E. Hinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Melnychuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Muschelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel F. Hanley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Issam A. Awad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wendy C. Ziai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Holly E. Hinson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hinson, H.E., Melnychuk, E., Muschelli, J. et al. Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage. Neurocrit Care 16, 399–405 (2012). https://doi.org/10.1007/s12028-011-9569-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-011-9569-9

Keywords

Search

Navigation