Lele Abhijit V, Prabhakar Hemanshu, Lin Victor, Kapoor Indu, Mahajan Charu, Athiraman Umeshkumar, Chaikittisilpa Nophanan, Abate Shiferaw Ananya, Mejia-Mantilla Jorge H, Tan Peter, Blacker Samuel
Neurocritical Care and Anesthesiology, Harborview Medical Center, Seattle, USA.
Neuroanaesthesiology and Neurocritical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Cureus. 2025 Apr 30;17(4):e83265. doi: 10.7759/cureus.83265. eCollection 2025 Apr.
This study aimed to evaluate the current practices, challenges, and quality improvement (QI) opportunities related to external ventricular drain (EVD) care in aneurysmal subarachnoid hemorrhage (aSAH) across low- and middle-income countries (LMICs). The findings were compared to international guidelines, including those by the American Heart Association (AHA), Neurocritical Care Society (NCS), and Society for Neuroscience in Anesthesiology and Critical Care (SNACC).
A cross-sectional survey was conducted between September and December 2024 using a 57-item questionnaire distributed to healthcare providers in LMICs. Data on EVD insertion and management, infection prevention, intracranial pressure (ICP) monitoring, transport practices, and QI metrics were analyzed descriptively, with thematic analysis of free-text responses.
Complete responses were received from 89 participants across 24 countries. Hydrocephalus was the primary indication for EVD insertion (96%), performed mainly in operating rooms (96%) by attending neurosurgeons (73%). Infection-related metrics were reported by 71% of respondents. Key areas for improvement included education, infection prevention, and standardized protocols. The adherence to AHA/NCS/SNACC recommendations was as follows: hydrocephalus as an indication for EVD insertion (96%), sterile technique (91%), EVD clamp trials (81%), indication-based CSF sampling (67%), pre-procedure antibiotics (61%), tunneling catheter (40%), use of anti-microbial-impregnated EVD (17%), and ICP during patient transport (13%). Conclusions: Significant gaps in EVD care in LMICs highlight the need for tailored QI initiatives. Leveraging campaigns like the SNACC EVD Safety Campaign can drive education, standardization, and improved outcomes. Future efforts should focus on context-specific guidelines and scalable QI practices in resource-limited settings.
本研究旨在评估低收入和中等收入国家（LMICs）中与动脉瘤性蛛网膜下腔出血（aSAH）患者的外部脑室引流（EVD）护理相关的当前实践、挑战和质量改进（QI）机会。研究结果与国际指南进行了比较，包括美国心脏协会（AHA）、神经重症监护学会（NCS）以及麻醉学与重症监护神经科学学会（SNACC）发布的指南。
2024年9月至12月期间进行了一项横断面调查，使用一份包含57个条目的问卷分发给LMICs的医疗服务提供者。对EVD置入和管理、感染预防、颅内压（ICP）监测、转运实践以及QI指标的数据进行了描述性分析，并对自由文本回复进行了主题分析。
来自24个国家的89名参与者提供了完整回复。脑积水是EVD置入的主要指征（96%），主要由神经外科主治医生（73%）在手术室（96%）进行操作。71%的受访者报告了与感染相关的指标。改进的关键领域包括教育、感染预防和标准化方案。对AHA/NCS/SNACC建议的遵循情况如下：脑积水作为EVD置入的指征（96%）、无菌技术（91%）、EVD夹闭试验（81%）、基于指征的脑脊液采样（67%）、术前使用抗生素（61%）、隧道式导管（40%）、使用抗菌涂层EVD（17%）以及患者转运期间的ICP监测（13%）。结论：LMICs在EVD护理方面存在显著差距，凸显了制定针对性QI举措的必要性。利用SNACC EVD安全运动等活动可以推动教育、标准化并改善结果。未来的努力应聚焦于资源有限环境下的因地制宜的指南和可扩展的QI实践。
