Use of a Novel Active-irrigation and Drainage (IRRAFLOW) System vs. Passive Drainage with EVD for Treatment of Intraventricular Hemorrhage

Introduction: Intraventricular hemorrhage (IVH) is a common neurosurgical pathology that can occur in isolation or along with intraparenchymal and subarachnoid hemorrhage and is associated with poor outcome. Hydrocephalus associated with IVH is often treated with external ventricular drain placement (EVD), though occlusion and replacement is common. We aimed to use the IRRAflow active and continuous, self-irrigating and drainage catheter system in patients with IVH, and compare outcomes with traditional EVDs.

Methods: A prospectively maintained database was retrospectively searched for consecutive patients who presented with IVH between September 2020 and October 2022. Data collected included patients’ demographics, medication history pertinent to anticoagulant and antiplatelet use, admission Glasgow Coma Scale (GCS) scores, pre-hospital modified Rankin Scale (mRS) score. Catheter occlusions, infections, and shunt placement was recorded for outcome assessment, along with total length of hospital and ICU stay, and in-hospital mortality.

Results: Twelve patients underwent active irrigation with drainage (IRRAflow) vs. 11 patients had an EVD placed. Mean GCS was 10.1 in the IRRAflow group vs. 8.8 in the EVD group. Pre-treatment 10 (83.3%) IRRAflow patients had hydrocephalus vs. 9 (81.8%) in EVD group. Three patients (25%) in the IRRAflow group received tPA in irrigation vs. none in the EVD group. IRRAflow patients required shorter duration for catheter placement (9.6 vs. 18.2 days) when compared to standard passive drain. Two patients (18.2%) in the EVD group had a shunt placement vs. none in the IRRAflow. Three (25%) patients had in-hospital mortality in the IRRAflow group vs. 5 (45.5%) in the EVD group.

Conclusion : IRRAflow patients had a lower in-hospital mortality rate, and shorter duration of catheter placement in patient presenting with intraventricular hemorrhage. Active irrigation with drainage using IRRAflow system seems to be safe and effective when compared to EVD for IVH patients.