Trial reportNeurocritical care2024
Analysis of Cerebral Spinal Fluid Drainage and Intracranial Pressure Peaks in Patients with Subarachnoid Hemorrhage.
Trial report in Neurocritical care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01258257 (EARLYdrain - Prospective Outcome Study of Early Lumbar Drainage in Aneurysmal Subarachnoid Hemorrhage), which is not on this map. Cited by 9 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
EARLYdrain - Prospective Outcome Study of Early Lumbar Drainage in Aneurysmal Subarachnoid Hemorrhage
Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Lumboperitoneal versus ventriculoperitoneal shunt surgery in adult post-hemorrhagic hydrocephalus: A systematic review and meta-analysis.Neurosurgical review · 2026Pooled it
- Going with the flow: lumbar cerebrospinal fluid drainage after aneurysmal subarachnoid hemorrhage: indications, safety, and practical considerations.Intensive care medicine · 2026Article
- Dynamic of Cerebrospinal Fluid and Acute-Phase Proteins After Subarachnoid Hemorrhage: The Lumbar Compartment as Blind Spot?Neurocritical care · 2026Article
- CSF diversion after aneurysmal sub-arachnoid hemorrhage: towards personalized treatment strategies.Critical care (London, England) · 2025Review
- Is There a Place for Cerebrospinal Fluid External Lumbar Drainage in Posttraumatic Intracranial Hypertension? Pros, Cons, and Uncertainties.Neurocritical care · 2025Article
- Beyond the bleed: complications after aneurysmal subarachnoid hemorrhage. Pathophysiology, clinical implications, and management strategies: a review.Critical care (London, England) · 2025Review
- Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics.Critical care (London, England) · 2025Review
- Analysis of Drainage Volume in External Ventricular Drainage Based on Intracranial Pressure and Drainage Catheter Size for Clinical Nurses.Healthcare (Basel, Switzerland) · 2025Article
- Influence of cerebrospinal fluid drainage in the first days after aneurysm rupture on the severity of early brain injury following aneurysmal subarachnoid hemorrhage.Acta neurochirurgica · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAfter aneurysmal subarachnoid hemorrhage (aSAH), elevated intracranial pressure (ICP) due to disrupted cerebrospinal fluid (CSF) dynamics is a critical concern. An external ventricular drainage (EVD) is commonly employed for management; however, optimal strategies remain debated. The randomized controlled Earlydrain trial showed that an additional prophylactic lumbar drainage (LD) after aneurysm treatment improves neurological outcome. We performed a post hoc investigation on the impact of drainage volumes and critical ICP values on patient outcomes after aSAH.
methodsUsing raw patient data from Earlydrain, we analyzed CSF drainage amounts and ICP measurements in the first 8 days after aSAH. Outcomes were the occurrence of secondary infarctions and the score on the modified Rankin scale after 6 months, dichotomized in values of 0-2 as favorable and 3-6 as unfavorable. Repeated measurements were considered with generalized estimation equations.
resultsEarlydrain recruited 287 patients, of whom 221 received an EVD and 140 received an LD. Higher EVD volumes showed a trend to more secondary infarctions (p = 0.09), whereas higher LD volumes were associated with less secondary infarctions (p = 0.009). The mean total CSF drainage was 1052 ± 659 mL and did not differ concerning infarction and neurological outcome. Maximum ICP values were higher in patients with poor outcomes but not related to drainage volumes via EVD. After adjustment for aSAH severity and total CSF drainage, higher LD volume was linked to favorable outcome (per 100 mL: odds ratio 0.61 (95% confidence interval 0.39-0.95), p = 0.03), whereas higher EVD amounts were associated with unfavorable outcome (per 100 mL: odds ratio 1.63 (95% confidence interval 1.05-2.54), p = 0.03).
conclusionsFindings indicate that effects of CSF drainage via EVD and LD differ. Higher amounts and higher proportions of LD volumes were associated with better outcomes, suggesting a potential quantity-dependent protective effect. Optimizing LD volume and mitigating ICP spikes may be a strategy to improve patient outcomes after aSAH. CLINICAL
trial registrationClinicalTrials.gov identifier: NCT01258257.
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