Presenters/Authors(s)

Gracie Monachello, Nicholas Brandmeir

Abstract or Description

Introduction

External ventricular drainage (EVD) is a common and life saving neurosurgical procedure but has a relatively high risk of complications. IRRAflow (IRRAS Inc., San Diego, CA, USA) is a new ventricular catheter that allows active fluid exchange of cerebrospinal fluid (CSF) and improved delivery of intrathecal medications, while maintaining intracranial pressure at safe levels. 

Objective

Our objective was to determine if the IRRAflow catheter decreased complications in ventricular drainage.

Methods

This is a multi-institutional, retrospective, cohort study. Charts of patients treated with ventricular drainage were queried for the type of drain, complications, and Modified Rankin scale (MRS) at admission, discharge, and 6 months. Other variables collected included demographics, treatment length, medications delivered, device settings, amount irrigated/drained, and the cause of termination of therapy. Binary outcomes were compared with chi-squared tests and reported as odds ratios (OR). 

Results

The IRRAflow catheter was associated with a significantly lower risk of all complications {OR .337 (.194-.587), p<0.0001}, patients with at least one complication {OR (.211-.780), p=0.0062}, failure to drain {OR .177 (.048-.654), p=0.0042}, early replacement {OR .335 (.111-1.009), p=0.0435}, and hemorrhage {OR .199 (0.063-0.632), p=0.003}. MRS at discharge and 6 months were not significantly different.

Conclusion

The IRRAflow catheter is associated with significantly lower rates of complications, failure to drain, early replacement, and hemorrhage. The IRRAflow can deliver intrathecal medications safely via continuous drip. Further study with prospective registries and randomized trials is warranted.