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Systematic review
Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage
  1. Allice Nyborg Rosenkrans Lind1,2,
  2. Mathias Green Krabbenhøft1,
  3. Jan Brink Valentin3,
  4. Mette Haldrup1,2,
  5. Stig Dyrskog4,
  6. Mads Rasmussen5,
  7. Claus Ziegler Simonsen2,6,
  8. Anders Rosendal Korshoej1,2
  1. 1Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  3. 3Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  4. 4Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
  5. 5Department of Anesthesiology, Gødstrup Regional Hospital, Herning, Denmark
  6. 6Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
  1. Correspondence to Dr Anders Rosendal Korshoej; andekors{at}rm.dk

Abstract

Background Subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale, cisternal irrigation has been proposed as a potential method to accelerate haematoma clearance in SAH. We aimed to provide a comprehensive review and meta-analysis evaluating the effect of intraventricular and cisternal irrigation on clinical outcomes in patients with SAH and IVH.

Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed preparing this systematic review and study selection was performed by multiple investigators. We extracted ORs from the individual studies and aggregated these using a random effects model. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluations assessment and ROBINS-I or RoB-2.

Results 24 articles were included. In SAH, we found that cisternal irrigation with fibrinolytic agents was associated with reduced mortality (OR: 0.68, 95% CI 0.46 to 1.00), higher probability of favourable functional outcome (OR: 1.80, 95% CI 1.30 to 2.51), and reduced risks of DCI (OR: 0.28, 95% CI 0.18 to 0.42) and cerebral vasospasm (OR: 0.28, 95% CI 0.18 to 0.42), compared with conventional therapy. Cisternal irrigation with vasodilatory agents was associated with lower mortality (OR: 0.32, 95% CI 0.13 to 0.79) and reduced risk of cerebral vasospasm (OR: 0.37, 95% CI 0.17 to 0.79). The evidence for irrigation therapy of IVH was sparse and insufficient to show any significant effect.

Conclusion In this study, we found that cisternal irrigation could improve the prognosis in patients with SAH compared with conventional therapy. There is no evidence to support cisternal irrigation treatment of IVH.

  • Hemorrhage
  • Intracranial Aneurysm
  • Subarachnoid

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2023-003062

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    Data availability statement

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    Footnotes

    • Contributors Guarantor: ARK, Concept and design: ARK, MH. Acquisition, analysis or interpretation of data: ARK, ANRL, MGK, MH. Drafting of the manuscript: ANRL, MGK, ARK. Critical revision of the manuscript for important intellectual content: ARK, ANRL, MGK, JBV, MH, SD, MR, CZS. Final approval of the manuscript version to be published: ARK, ANRL, MGK, JBV, MH, SD, MR, CZS. Statistical analyses: ANRL, ARK, JBV.

    • Funding ARK is supported by grants from the Danish Cancer Society (R304-A17698-B5570 and R295-A16770), the Lundbeck Foundation (R325-2019-1490) and the Independent Research Fund Denmark (903900307B) unrelated to this study. MR is supported by a grant from The Health Research Fund of Central Denmark Region unrelated to this study. CZS is supported by grants from The Health Research Fund of Central Region Denmark and the Novo Nordisk Foundation unrelated to this study.

    • Competing interests ARK reports grants from IRRAS AB to Aarhus University Hospital to support the ACTIVE study and personal fees from IRRAS AB for a presentation at a scientific symposium describing his experiences with the IRRAflow technology during the conduct of the study; grants from IRRAS AB to Aarhus University Hos-pital to support the development of a neuromonitoring technology related to IRRAflow outside the submitted work; in addition, ARK has a patent for a neuromonitoring technology pending with relation to the IRRAflow technology. The remaining authors have no conflicts of interest to declare.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.