title: Drainage efficiency with dual versus single catheters in severe intraventricular hemorrhage.
abstract: BACKGROUND
  Little is known about the efficacy of single versus dual extraventricular drain (EVD) use in intraventricular hemorrhage (IVH), with and without thrombolytic therapy.
  
  
  METHODS
  Post-hoc analysis of seven patients with dual bilateral EVDs from two multicenter trials involving 100 patients with IVH, and spontaneous intracerebral hemorrhage (ICH) volume <30 ml requiring emergency external ventricular drainage. Seven "control" patients with single catheters were matched by IVH volume and distribution and treatment assignment. Head CT scans were obtained daily during intraventricular injections for quantitative determination of IVH volume.
  
  
  RESULTS
  Median [min-max] age of the 14 subjects was 56 [40-73] years. Median duration of EVD was 7.9 days (single catheter group) versus 12.2 days (dual catheter group) (P = 0.34). Baseline median IVH volume was not significantly different between groups (75.4 ml [22.4-105.1]--single EVD vs. 84.5 ml [42.0-132.0]--dual EVD; P = 0.28). Comparing the change in IVH volume on time-matched CT scans during dual EVD use, the median decrease in IVH volume in dual catheter patients was significantly larger (52.1 [31.7-81.1] ml) versus single catheter patients (34.5 [13.1-73.9] ml) (P = 0.004). There was a trend to greater decrease in IVH volume during dual EVD use in both rt-PA (P = 0.9) and placebo-treated (P = 0.11) subgroups.
  
  
  CONCLUSIONS
  The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy.
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N Wolfe St, Baltimore, MD, USA. hhinson1@jhmi.edu
authors.forename: Holly E
authors.initials: HE
authors.lastname: Hinson
authors.forename: Eric
authors.initials: E
authors.lastname: Melnychuk
authors.forename: John
authors.initials: J
authors.lastname: Muschelli
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hanley
authors.forename: Issam A
authors.initials: IA
authors.lastname: Awad
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Ziai
mesh_terms: D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods; D003422:Critical Care / Q000379:methods*; D004322:Drainage / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome