External Ventricular Drain Management in Aneurysmal Subarachnoid Hemorrhage: Perspectives and Practices From Low-Income and Middle-Income Countries

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.