{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T21:59:20Z","timestamp":1780955960995,"version":"3.54.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005743","name":"Universit\u00e0 Cattolica del Sacro Cuore","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The EARLYDRAIN trial demonstrated the efficacy of lumbar drainage (LD) in aneurysmal subarachnoid hemorrhage (aSAH) but did not differentiate between patients requiring dual drainage [LD plus external ventricular drainage (EVD)] versus single-catheter management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of this study was to investigate the safety and additive efficacy of simultaneous double drainage (EVD\u2009+\u2009LD) compared with isolated EVD in patients with high-grade aSAH, stratifying by actual device usage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This secondary analysis stratified 254 EARLYDRAIN trial participants on the basis of daily intensive care unit (ICU) device records. To minimize selection bias, the isolated LD cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943), characterized by significantly milder admission severity (mean Glasgow Coma Scale (GCS) 13.3,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), was excluded from efficacy models. The primary analysis compared simultaneous double drainage (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992) vs. isolated EVD (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009119). Multivariable logistic regression models were adjusted for age, Hunt\u2013Hess grade, modified Fisher grade, and total cerebrospinal fluid (CSF) drainage volume.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Double drainage and isolated EVD groups were well balanced for admission GCS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.672) and intraventricular hemorrhage prevalence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.355). Suspected infection rates were similar (47.8% vs. 44.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.631). In multivariable analysis, the drainage strategy (double vs. EVD) was not an independent predictor of clinical vasospasm (OR 1.02,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.950), permanent shunt dependency (OR 0.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.382), or unfavorable functional outcome (mRS 3\u20136) at 6\u00a0months (OR 0.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.336). Instead, shunt dependency was independently predicted by higher total CSF drainage volume (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and age. Conversely, unfavorable functional outcome was driven exclusively by admission Hunt\u2013Hess grade (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with total CSF volume showing no significance (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.704).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with high-grade aSAH, the addition of a lumbar drain to an EVD is safe but does not independently mitigate vasospasm or improve functional outcomes when adjusted for injury severity. High-volume CSF drainage predicts shunt dependency but is not a marker of functional recovery, suggesting a \u201cvolume paradox\u201d in severe hydrocephalus. Yet, because this was not a prespecified analysis, it is not possible to definitively establish the superiority of a dual-drainage strategy over ventricular drainage alone. Therefore, these results should be interpreted as exploratory.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-026-02565-5","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T21:21:23Z","timestamp":1780953683000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Safety and Additive Efficacy of Dual CSF Drainage (Ventricular\u2009+\u2009Lumbar) in Severe Aneurysmal Subarachnoid Hemorrhage: A Secondary Analysis of the EARLYDRAIN Trial"],"prefix":"10.1007","author":[{"given":"Gianluca","family":"Trevisi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Palermo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"D\u2019Arrigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Doglietto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Albanese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4080-2492","authenticated-orcid":false,"given":"Carmelo Lucio","family":"Sturiale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2565_CR1","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1016\/S0140-6736(22)00938-2","volume":"400","author":"J Claassen","year":"2022","unstructured":"Claassen J, Park S. 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