An external ventricular drain (EVD) or ventriculostomy is a multi-orifice catheter inserted into a cerebral ventricle of a patient with acute symptomatic hydrocephalus due to spontaneous subarachnoid hemorrhage, intracerebral/intraventricular hemorrhage, or traumatic brain injury. It is estimated that more than 25,000 patients receive an EVD every year in the United States (Br J Neurosurg 2008;22:213-8). Anesthesiologists manage patients with EVDs regularly in the OR or the interventional radiology suite, as well as assist with the transport of patients with EVDs to and from the intensive care unit.

A worldwide survey of anesthesiologists found that many anesthesiologists are not comfortable managing EVDs in their practice. Multiple studies have shown that EVDs are routinely clamped during the intrahospital transfer of critically ill patients and that intracranial pressure is not routinely monitored during transport (J Neurosurg Anesthesiol 2020;32:132-9; Neurocrit Care 2017;26:196-04; World Neurosurg 2019;126:e743-52; J Clin Med 2023;12:3183; J Neurosurg Anesthesiol 2022;34:21-8). This exposes some patients to unnecessary and often dangerous elevations in intracranial pressure due to their reduced intracranial compliance (similar to a tension pneumothorax that develops in a patient with a chest tube that is inadvertently clamped). In addition, EVD-associated complications such as over-drainage and under-drainage of CSF occur in the perioperative setting. Fortunately, efforts to improve the clinical proficiency of perioperative health care providers in the management of EVDs have yielded positive results, in which knowledge was gained after a review of an online educational module (J Neurosurg Anesthesiol 2023;35:201-7).

Table 1: The EVD Safety Campaign Goals and Objectives

Table 1: The EVD Safety Campaign Goals and Objectives

After the publication of the guidelines for perioperative management of patients with EVDs by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and due to the continued concerns regarding quality and patient safety regarding perioperative EVD management, SNACC is launching a robust global patient safety initiative called “The EVD Safety Campaign” (J Neurosurg Anesthesiol 2017;29:191-210; asamonitor.pub/4c4HBe4). This campaign was created and led by SNACC and endorsed by the Anesthesia Patient Safety Foundation.

Table 2: The EVD Knowledge Hub

Table 2: The EVD Knowledge Hub
An EVD Knowledge Hub has been created and can be accessed free of charge by visiting SNACC’s website (asamonitor.pub/3Vy65ql).

We encourage all anesthesiologists to join this campaign to promote quality and safety in EVD care. If you and your site want to be recognized as participating sites in this campaign on SNACC’s campaign website, please scan the QR code (Figure) to enter information about your hospital’s participation in the EVD safety campaign.