Pressure-controlled active CSF irrigation versus non-pressure-controlled management following aneurysmal subarachnoid hemorrhage: a systematic review and comparative meta-analysis of DCI and safety outcomes.
Ramtin Pourahmad, Mehrad Zare, Pouria Delbari et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the effectiveness and safety of pressure-controlled cerebrospinal fluid (CSF) irrigation versus non-pressure-controlled management in patients with aneurysmal subarachnoid hemorrhage (aSAH). The analysis included nine studies with 2,033 patients. Pressure-controlled irrigation was associated with lower odds of delayed cerebral infarction (OR 0.36, 95% CI 0.25-0.50) and symptomatic vasospasm (OR 0.48, 95% CI 0.27-0.88).
Key findings
- Pressure-controlled irrigation reduced the odds of delayed cerebral infarction (OR 0.36, 95% CI 0.25-0.50).
- Lower odds of symptomatic vasospasm were observed with pressure-controlled irrigation (OR 0.48, 95% CI 0.27-0.88).
- Imaging-defined vasospasm was also less likely with pressure-controlled techniques (OR 0.33, 95% CI 0.23-0.48).
- No significant differences were found for in-hospital mortality (OR 1.19, 95% CI 0.83-1.69).
Why it matters
Understanding the comparative effectiveness of pressure-controlled CSF irrigation can inform clinical decision-making in managing aSAH, particularly regarding the prevention of delayed cerebral infarction and vasospasm, which are critical for improving patient outcomes.
What to keep in mind
The majority of included studies were observational and at serious risk of confounding, limiting the strength of the conclusions.