Treatment of Intraventricular Hemorrhage with External Ventricular Drainage and Fibrinolysis: A Comprehensive Systematic Review and Meta-Analysis of Complications and Outcome

- BACKGROUND: External ventricular drainage (EVD) is a key factor in the treatment of intraventricular hemorrhage (IVH) but associated with risks and complications. Intraventricular fibrinolysis (IVF) has been proposed to improve clinical outcome and reduce complications of EVD treatment. The following review and metaanalysis provides a comprehensive evaluation of IVH treatment with external ventricular drainage (EVD) and intraventricular fibrinolysis (IVF) with regards to complications and clinical outcomes. - METHODS: The PRISMA guidelines were followed preparing this review. Studies included in the meta-analysis were compared using forest plots and the related odds ratios.- RESULTS: After a literature search, 980 articles were identified and 65 and - nderwent full-text review. Forty-two articles were included in the review and meta-analysis. We found that bolted and antibiotic-coated catheters were su- perior to tunnelled/uncoated catheters (P < 0.001) and antibiotic- vs. silver - impregnated catheters (P < 0.001]) in preventing infection. Shunt dependency was related to the volume of blood in the ventricles but unaffected by IVF (P=0.98). IVF promoted hematoma clearance, decreased mortality (22.4% vs. 40.9% with IVF vs. no IVF, respectively, P < 0.00001), improved good functional out- comes (47.2% [IVF] vs. 38.3% [no IVF], P=0.03), and reduced the rate of catheter occlusion from 37.3% without IVF to 10.6% with IVF (P=0.0003).- CONCLUSIONS: We present evidence and best practice recommendations for the treatment of IVH with EVD and intraventricular fibrinolysis. Our analysis further provides a comprehensive quantitative reference of the most relevant clinical endpoints for future studies on novel IVH technologies and treatments.

Automated summary

This review and meta-analysis evaluate the effects of external ventricular drainage (EVD) and intraventricular fibrinolysis (IVF) on complications and clinical outcomes of intraventricular hemorrhage (IVH) treatment. The results show that antibiotic-coated catheters are more effective in preventing infection compared to tunnelled/uncoated catheters, and rifampicin-coated catheters are more effective than silver-impregnated catheters. IVF promotes hematoma clearance, reduces mortality, improves functional outcomes, and decreases the rate of catheter occlusion.