Continuous Lumbar Drainage for Subarachnoid Hemorrhage: A Systematic Review

Objective To assess the ef ectiveness and safety of continuous lumbar drainage of cerebrospinal l uid for subarachnoid hemorrhage(SAH). Methods The Cochrane Library(January 1992 to May 2013), Medline(January 1950 to May 2013), Sino Med(January 1979 to May 2013), CNKI(January 1979 to May 2013), and Wanfang Database(January 1979 to May 2013) were searched for randomized controlled trials(RCTs) on continuous lumbar drainage for SAH. The method of Cochrane systematic review was used to evaluate all the included RCTs. Results Twelve RCTs(857 patients) met the inclusion criteria, but the general methodological quality of trials was poor. Only two studies addressed the outcomes about SAH patients' death, vegetative state or disability and other adverse events at the end of the followup period(at least 3 months). Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal l uid for SAH than the control group with statistical signifficance [RR=0.27, 95%CI(0.12, 0.59), P=0.001]. Meta-analysis of complications also showed a better ef ect of lumbar continuous drainage of the cerebrospinal l uid for SAH than the control group with statistical signifficance(except re-bleeding) [cerebral vasospasm: RR=0.20, 95%CI(0.14, 0.30), P 0.000 01; hydrocephalus: RR=0.24, 95%CI(0.13, 0.41), P 0.000 01; cerebral infarction: RR=0.27, 95%CI(0.16, 0.45), P 0.000 01]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal l uid including intracranial infection and intracranial hypotension reaction, while the others did not report the adverse events. Conclusions WitThpoor quality of the most included trials, insuficient evidence is obtained to support the conclusionthat lumbar continuous drainage of the cerebrospinal fluid is safe and effective in the treatment of SAH. Further highquality RCTs should be carried out to provide more reliable evidences.