Outcomes and complications of external ventricular drainage in primary and secondary intraventricular hemorrhage: a descriptive observational study

Objective: Intraventricular hemorrhage (IVH) is a serious condition with high mortality rates and poor functional outcome in survivors. Treatment includes external ventricular drains (EVDs), which are associated with several complications. This study reports the clinical outcome and complication rate in patients with primary IVH (pIVH) and secondary IVH treated with EVDs.

Methods: The authors conducted a retrospective observational study using the Danish National Patient Registry. Patients treated with EVDs for pIVH or secondary IVH between September 2012 and August 2022 at Aarhus University Hospital were included. Demographic data, clinical treatment, and outcomes were extracted and analyzed.

Results: A total of 436 patients with 615 EVDs were included. Of these, 4.1% had pIVH, 60.6% had IVH secondary to subarachnoid hemorrhage, and 35.3% had IVH secondary to intracerebral hemorrhage. During EVD treatment, 38.8% of patients experienced complications, including complete occlusion (17.2%), partial occlusion (16.1%), ventriculitis (7.1%), and other complications (9.6%). Of patients surviving the initial 30 days, 34.2% received a ventriculoperitoneal shunt, and 29.9% remained shunt dependent 6 months after inclusion. Mortality rates were 28.9% at 30 days and 33.7% at 90 days. A total of 31.0% of patients had good functional outcomes at 90 days.

Conclusions: This study provides a comprehensive historical reference of complications, mortality rate, and functional outcome of EVD-treated patients with pIVH and secondary IVH. These findings provide a baseline for evaluating novel catheter-based interventions in IVH management.