External ventricular drainage for intraventricular hemorrhage

Background: Intervention to reduce intracranial pressure using External Ventricular Drain (EVD) is a common life saving measure in a neurosurgery intensive care unit(ICU). Objective: The present study was undertaken to assess the outcome of patients who underwent external ventricular drainage for intraventricular hemorrhage(IVH). Methods: The available data of the patients who underwent placement of external ventricular drain from February 2012 to May 2016 for intraventricular hemorrhage (IVH) at Narayana Medical College and Hospital, Nellore, was retrieved from the hospital case records and analyzed. Results: Total of 69 patients were included in this study. Mean age was 53.7 ±11.6 years. Clinical presentation included altered sensorium in 66 patients (96%), hemiparesis in 62 patients (90%) , vomiting in 40 patients (58%) and seizures in 9 patients (13%). Fifty two patients (75%) were known hypertensives and 10 patients (15%) were diabetic. Past history of smoking was recorded in 16(23%) patients and alcohol intake in 17 patients (25%). GCS at the time of admission was 3-8 (low) in 39 patients (57%), 9-12 in 23 patients(33%) and 13-15 in 7 patients (10%). At the time of admission, 60 patients ( 87%) had diastolic blood pressure more than 90 mmHg, 63 patients (91%) had systolic blood pressure more than 140 mmHg. Major site of hemorrhage was basal ganglia in 24 (35%), thalamus in 13 (19%), cerebellum in 5 (7%), brain stem in 3, frontal/temporal in 2 patients. SAH with IVH was noted in 12 patients (17%) and only IVH was noted in 10 patients (14%). Mean duration of external ventricular drainage was 4.6+1.7 days (Range 1-9 days). Mean hospital stay was 11.3±7.5 days and mean ICU stay was 8+5.4 days. Thirty eight patients (55%) died during hospital stay. At the time of discharge, poor out come (Glagow out come score 1-3) was noted in 52 patients (75%) and good out come (Glagow out come score-4,5) was noted in 17 patients. Among various parameters analyzed , poor GCS (3-8) at admission, history of smoking and alcohol intake were found to correlate significantly with poor outcome. None of the other factors like old age, site of bleed, pupillary asymmetry at admission, high blood pressure at admission, past history of hypertension and diabetes were found to correlate with poor outcome. Conclusions: Majority of the patients with intracranial hematomas with intraventricular extension presented in poor neurological condition (GCS= 3-8). Poor neurological condition at the time of admission, past history of smoking and alcohol intake were associated with poor outcome.