Objective:

Background:

The optimal duration of external ventricular drain (EVD) in patients with aneurysmal subarachnoid hemorrhage (aSAH) is debatable. We sought to determine the association of EVD duration with outcomes, including cerebral infarct.

Design/Methods:

We performed a retrospective study of a prospectively collected cohort of consecutive patients with aSAH who were admitted to an academic center from 2016 to 2023. Multivariate logistic regression was used to determine the association of EVD duration with outcomes, including cerebral infarct prior to discharge (excluding immediate post aneurysm securement infarcts) and a shift in 3-month modified Rankin Scale (mRS). Hospital mortalities were excluded in functional outcome ordinal shift analysis.

Results:

We reviewed 429 cases of aSAH and included 306 patients who received EVD with mean age 57.9 years (SD 13.9), 67% female and 69% white. EVD duration was longer in patients with cerebral infarcts compared to those without infarcts (mean 15.8 days [SD 13.7] vs 13 [11.8]; p=0.016). Longer EVD duration was associated with higher odds of cerebral infarct (OR 1.04 for each day increase, 95% CI 1.01-1.07; p=0.003) independent of age, sex, Hunt and Hess grade, modified Fisher score and aneurysm securement mode. However, EVD duration was not associated with worse functional outcome (OR 1.02, 95% CI 0.98-1.06; p=0.23) when adjusted for other predictors.

Conclusions:

Longer EVD duration may not improve functional outcome and can be associated with more cerebral infarcts in patients with aSAH. Unnecessary prolongation of EVD duration should be discouraged. Larger prospective studies are needed to confirm these findings.