Efficacy and Predictors of Success of External Ventricular Drainage for the Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study.

Abstract

Background: External ventricular drainage (EVD) is commonly used to manage elevated intracranial pressure (ICP) following traumatic brain injury (TBI). However, evidence supporting its effectiveness in this context remains limited. This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success.

Methods: A multicenter retrospective cohort study was conducted between January 1, 2019, and December 31, 2022, across nine regional trauma centers in France participating in the Traumabase registry. All patients with TBI with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an effective control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions.

Results: A cohort of 176 patients with TBI treated with EVD was included. Among these patients, 88 (50%) achieved sustained control of ICP after EVD, with few complications reported (health care-associated ventriculitis: 3%, significant hematoma [> 1 cm] on EVD path: 3%). In the multivariate analysis, sedation with a combination of sedative drugs (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12-0.62, p = 0.002), obliterated basal cisterns on the brain computed tomography scan prior to EVD placement (OR 0.07; 95% CI 0.00-0.39, p = 0.013), and severity of chest trauma (OR 0.79; 95% CI 0.64-0.99, p = 0.039) were factors associated with poor likelihood of EVD success. Conversely, EVD placement occurring more than 24 h after admission was independently associated with success (OR 3.07; 95% CI 1.41-7.01, p = 0.006).

Conclusions: In this multicenter cohort of patients with TBI with refractory intracranial hypertension, EVD effectively controlled ICP in half of the cases. The effectiveness of EVD appears to depend on clinical and radiological markers of severity of traumatic intracranial hypertension.