A subarachnoid hemorrhage involves bleeding into the space between the brain and its surrounding membrane. A common cause is the rupture of an aneurysm – a weak spot in a blood vessel of the brain. Almost all patients present with the worst headache of their life, and those who are severely affected may lose consciousness. A subarachnoid hemorrhage is a life-threatening emergency, with a significant proportion of patients dying or suffering life-long sequelae. Read More
For most patients, standard care involves drainage of their brain ventricles to relieve high intracranial pressure. To prevent recurrent bleeding, the aneurysm is secured by clipping or coiling. However, this does not address the effects of the leaked blood. It can cause blood vessels to spasm, leading to secondary infarctions. To date, a reliable way to remove the leaked blood has not been rigorously tested.
To address this, Dr Stefan Wolf of the Charité University Hospital in Berlin and colleagues have implemented the EARLYDRAIN trial, which investigates the use of lumbar drains in patients with subarachnoid hemorrhage.
A lumbar drain involves inserting a hollow plastic tube into the lower spine, allowing cerebrospinal fluid to slowly drain. Blood cells leaking from the brain are denser than the surrounding cerebrospinal fluid and tend to sink. In contrast to draining a patient’s ventricles, the lumbar drain may facilitate better removal of the blood by the simple use of gravity. In EARLYDRAIN, the researchers applied the lumbar drain as early as possible to thoroughly test its potential.
The researchers conducted the trial in 19 hospitals in Germany, Switzerland and Canada. They recruited 144 patients with subarachnoid hemorrhage who received a lumbar drain in addition to standard care. 143 patients received standard care alone in a control group. Lumbar drain began the day after aneurysm treatment and proceeded for at least 4 days. In unconscious patients, a small difference between brain ventricles and lumbar drain – or no difference – was used to indicate open cerebrospinal fluid pathways and enhance safety.
At a 6-month follow up, 44.8% of the ‘standard care’ control group experienced adverse neurological outcomes compared with just 32.6% of the lumbar drain group. In addition, 57 patients in the control group showed secondary infarctions, compared with just 41 in the lumbar drain group. The investigators noted no safety concerns associated with adding a lumbar drain.
The EARLYDRAIN results show that lumbar drains can successfully reduce adverse outcomes for patients with subarachnoid hemorrhage, and the researchers recommend their use in addition to the standard care.
