Does the Setting of External Ventricular Drain Placement Affect Morbidity? A Systematic Literature Review Comparing Intensive Care Unit versus Operating Room Procedures

Abstract

External ventricular drain (EVD) placement can be performed at the bedside in the neurosurgical intensive care unit (ICU) or in the operating room (OR). Systematic review and meta-analysis may permit stronger recommendations to improve accuracy and complication rates. Systematic review of PubMed was performed (inception-December 12, 2019) following PRISMA guidelines. Our search yielded 356 articles, of which 37 studies underwent full-text analysis. Nine studies met inclusion criteria. Studies were segregated into OR only (n= 3; 1011 patients), ICU only (n= 3; 325 patients), and OR+ ICU (n= 3; 613 patients) cohorts. Studies were in addition divided by outcome measures, including catheter placement accuracy (ICU, 4 studies, n= 280 [68.29%] vs. OR, 2 studies, n= 198 [84.25%]); iatrogenic hemorrhagic complications (ICU, 4 studies, n= 112 [18.16%] vs. OR, 2 studies, n= 35 [17.50%]); and ventriculostomy-related infection rates (ICU, 4 studies, n= 48 [7.28%] vs. OR: 5 studies, n= 92 [8.06%]). There are likely specific patient populations who would benefit from EVD placement in the ICU versus OR setting. The literature comparing efficacy and morbidity between EVDs placed in the ICU and OR settings is overall inconclusive in both sample size and congruence of methodology. Agreement in outcome metrics and data reporting on this topic is necessary to synthesize high-quality evidence to form practice-changing recommendations for this debated topic.