Lumbar drains after coiling for subarachnoid hemorrhage (EARLYDRAIN trial)
In people with nontraumatic subarachnoid hemorrhage, despite coiling or clipping of the culprit aneurysm and prophylactic nimodipine, ischemic vasospasm and secondary brain injury frequently develop. As a result, most people who experience subarachnoid hemorrhage due to aneurysm die or are severely disabled. (Historically, almost 40% of those with aneurysmal SAH died within 30 days. With systematic improvements in interventions, ICU management and transport to expert centers, case-fatality rates and disability in SAH have been steadily improving over the past 20 years, but remain high.)
It's possible that blood products in the cerebrospinal fluid space after SAH are responsible for vasospasm, and removing them via lumbar drain might help. The LUMAS randomized trial did not show benefit of lumbar drains in SAH, but enrolled patients with less-severe bleeds, making it harder to detect a benefit of lumbar drainage.
In the EARLYDRAIN trial, authors randomized 307 patients with aneurysmal …
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