Table 2. Efficacy measures of ELD reported by included studies.
*denotes where no summary statistics are available
TBI = traumatic brain injury, SAH = subarachnoid haemorrhage, ICH = intracerebral haemorrhage, EH = external hydrocephalus, EVD = external ventricular drain, ICP = intracranial pressure, CPP = cerebral perfusion pressure
| Authors | Cohort | EVD? | ELD volume drained | Effect on ICP and summary statistics | CPP control outcomes | Prevention of TIL escalation? |
| Abadal Centellas et al., 2007 [29] | n =17 (adults, TBI) | No | Initial drainage of CSF to low ICP as described was 8.0 +/- 5.7 mL. | Mean ICP before and one hour after placement of ELD was 30.9 +/- 7.9 and 14.1 +/- 5.9 mm Hg. Excellent/good control of ICP achieved in 76% by day one and 94% by day three. * | Improvement in CPP in all patients | Excellent control of ICP (no mannitol or hypertonic saline used over 24hr period) in 94% day three post ELD |
| Bauer et al., 2017 [31] | n=8 (adults, TBI) | No | 23.5 ml/24 h (mean, SD 16.41, range 0–40 ml) | Lumbar CSF removal led to a reduction of ICP in all patients. Mean ICP was 22.3 mmHg (SD 3.0) before CSF drainage and was 13.9 mmHg (SD 4.7) after drainage (p = 0.002). | Not documented | Not reported |
| Levy et al., 1995 [32] | n=16 (children, TBI) | Yes in all | Not stated | Fourteen of the 16 children had an abrupt and lasting decrease in ICP after placement of the lumbar drain, which obviated the need for continued aggressive medical therapy * | CPP improved in one case, otherwise not documented | Not reported |
| Llompart Pou et al., 2011 [33] | n=30 (adults, TBI) | No | Not stated | ICP before and one hour after ELD placement was 33.7±9.0 and 12.5±4.8 mmHg respectively, a decrease in ICP of 21.2±8.3 mmHg (p < 0.0001) | Not documented | Not reported |
| Manet et al., 2016 [34] | n= 4 (adults, TBI, EH) | No | Not stated | This procedure resulted in the immediate and long-lasting control of ICP: decrease from mean ICP of 37 ± 5 to mean 5 ± 2. * | Not documented | Not reported |
| Manet et al., 2017 [35] | n=33 (adults, TBI/SAH/ICH, EH) | Mixed (8 of 33) | Median CSF flow was 119 ml (96–280) per day | The ELD procedure led to a marked averaged reduction of ICP over the following 6 h by 16 mmHg (13–24), from 25 mmHg (20–31) before to 7 mmHg (3–10) after ELD (p < 0.001) | Not documented | Sedation was reduced in 25 patients (75%) within 24hr after ELD insertion |
| Murad et al., 2012 [25] | n=15 (adults, TBI/SAH) | Yes in all | Not stated | Reduced from mean of 28.2 mm Hg +/- 6.5 to 10.1 +/- 7.1 (p < 0.001). Requirements for hyperosmolar therapy, sedatives, paralytics decreased (p < 0.05) | CPP increased from 76.7 mmHg +/- 19.8 to 81.2 +/-10.2 | Reduced patients requiring boluses of osmotic therapy from 12/15 to 1/15 |
| Tuettenberg et al., 2009 [23] | n=100 (adults, TBI/SAH) | Mixed (84 of 100) | Not stated | Significant reduction in ICP from 32.7 ± 10.9 to 13.4 ± 5.9 mm Hg (p < 0.05) | Increase in CPP from 70.6 ± 18.2 to 86.2 ± 15.4 mm Hg (p < 0.05) | All modalities reduced except hyperventilation |
| Willemse, 1998 [37] | n=7 (adults, TBI) | Yes in all | Not stated | Five of the seven patients had a lasting decrease in ICP after lumbar drainage and survived.* | Not documented | N/A |