Abstract 114: LACROSSE Trial: Lumbar Drainage Compared to External Ventricular Drainage in Aneurysmal Subarachnoid Hemorrhage, a Randomized Control Trial

Introduction: Delayed cerebral ischemia (DCI) is a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). External ventricular drainage (EVD) has been regarded as the gold standard, but lumbar drains (LD) may impact the rate of DCI due to preferential clearing of subarachnoid blood. Recent trials have not directly compared these drains therefore our goal was to determine if LD is superior to EVD for prevention of DCI in aSAH. Methods: A randomized controlled trial was initiated at UC San Diego, the University of Rochester, and Rochester Regional to randomize drain placement to either EVD or LD in aSAH patients. The primary outcome was DCI, defined as an exclusionary change in GCS or new, none-treatment related infarcts on imaging. Secondary outcomes were ICU measures and functional outcomes. Results: 52 patients were enrolled. The rate of DCI was significantly lower in the LD arm (7.4%, 2/27) compared to the EVD arm (36%, 9/25) (p=0.017) with a NNT of 3.5 for LD. There was no significant difference between the two arms with regards to admission characteristics, aneurysm location, treatment type, or total number of vasospasm treatments. LD patients spent fewer days in the ICU (p=0.015), on a ventilator (p=0.004) and had fewer drain days (p=0.003) compared to EVD patients. The proportion of patients with functional independence was significantly higher in the LD group compared to the EVD group 1-month post-hemorrhage (BI p = 0.04; GOS p = 0.04) Conclusions: In this trial, we show that LD is superior to EVD in aSAH patients in the reduction of DCI, is associated with significantly improved clinical outcomes, and reduced utilization of ICU resources.