Lumbar drainage linked to improved outcomes at 6 months after subarachnoid hemorrhage

Key takeaways:

• EARLYDRAIN trial included 287 adults randomly assigned to receive lumbar drainage with standard care or standard care alone.
• Lumbar drainage led to fewer infarctions, reduced unfavorable outcomes at 6 months.

Lumbar drainage following an aneurysmal subarachnoid hemorrhage was effective at reducing infarction and decreased rates of unfavorable neurological outcome at 6 months, according to data published in JAMA Neurology.

“Subarachnoid hemorrhage from the rupture of an intracranial aneurysm is a type of stroke leading to death or permanent disability in most affected patients,” Stefan Wolf, MD, of the department of neurosurgery, Charite-Berlin University of Medicine, and colleagues wrote. “In retrospective studies, prophylactic lumbar drainage of cerebrospinal fluid was associated with favorable outcome.”

Researchers aimed to determine efficacy of early lumbar cerebrospinal fluid drainage in conjunction with standard care following aneurysmal subarachnoid hemorrhage.

They conducted the EARLYDRAIN trial — a multicenter, parallel-group, open-label randomized clinical trial — held at 19 hospitals in Germany, Switzerland and Canada. A total of 287 individuals diagnosed with acute aneurysmal subarachnoid hemorrhage (median age 55 years; 68.6% women) were randomly assigned 1:1 to receive either an additional lumbar drain following aneurysm alongside standard care or standard care only. Aneurysm treatment with clipping or coiling was performed within 48 hours of hemorrhage onset, whereas lumbar drainage at 5 mL per hour was begun within 72 hours of the hemorrhage. The primary outcome for the study was rate of unfavorable result, as measured by a score of 3 to 6 on the modified Rankin Scale 6 months after hemorrhage.

According to results, 47 patients (32.6%) in the lumbar drain group and 64 patients (44.8%) in the standard care group logged an unfavorable outcome (RR = 0.73; 95% CI, 0.52-0.98; absolute risk difference = 0.12; 95% CI, 0.23 to 0.01) at the 6-month follow-up.

Researchers also found that participants given a lumbar drain recorded fewer secondary infarctions at discharge (41 vs. 57 patients; RR = 0.71; 95% CI, 0.49-0.99; absolute risk difference = 0.11; 95% CI, 0.22 to 0) compared with those in the standard care cohort.

“Prophylactic lumbar cerebrospinal fluid drainage is warranted to lessen the burden of infarction at discharge and reduce the rate of unfavorable outcome at 6 months,” Wolf and colleagues wrote.