Proven Advantages of Automated CSF Management in TAAA Repair

The thoracoabdominal aortic aneurysm repair (TAAA) procedure requires CSF drainage equipment because, during the procedure, cross‐clamping often interrupts blood supply to the spinal cord. Pressure to the spinal cord then increases the risk of ischaemic spinal cord injury, leading to blood pressure drops, paraplegia, and even tissue damage and death.

Draining cerebrospinal fluid from the lumbar region can lessen the CSF pressure, open blood flow to the spinal cord and reduce spinal cord injury risks. Surgeons utilizing appropriate CSF drainage equipment during TAAA are more likely to avoid catastrophic outcomes. Here, we discuss how automated CSF drainage equipment makes TAAA procedures safer for patients, less stressful for surgeons, and more comfortable for both.

Standard Gravity CSF Drainage Equipment Limitations

Today, gravity-based drip chambers are the most commonly used cerebrospinal fluid management systems. These CSF management systems have several drawbacks, however, including:

  • Failure of accurate pressure management during drainage. Gravity drains without an added pressure sensor do not allow for pressure monitoring, only drainage.
  • Practitioner handling mistakes impacting safety and sterility of the equipment, involving:
    • air filter congestion
    • incorrect alignment of the drip chamber and patient
    • incorrect tubing connections
    • stopcock fitting and positioning

Even the most experienced surgeons and staff cannot accurately gauge CSF pressure when touching or glancing at the tubing. Tube contents can build to dangerous pressure levels before practitioners intervene. Then, when multitasking surgical staff feels rushed, they often fall victim to human error that results in mistakes in drainage system setup and management. Further, the repeated manual manipulation involved with gravity CSF drainage systems almost inevitably leads to an increased risk of catheter infection and subsequent meningitis.

Advantages of Automated Cerebrospinal Fluid Drainage Systems

A automated CSF management system helps surgeons and patients avoid the negative outcomes listed above.

  1. First, the pressure sensor and tubing integral to an automated CSF drainage registers CSF pressure changes within milliseconds. Staff using manual systems often take up to 15 minutes to respond to CSF pressure. The automated system monitors and clearly displays:
    • hourly drainage volume
    • maximum and minimum CSF pressure,
    • acceptable maximum amount drained per hour
  2. An automated CSF drainage system reduces risk of contamination. Its easy-to-read, colorful display quickly trains surgeons and staff to monitor CSF pressure levels with just a glance. Manual CSF drainage, on the other hand, involves professionals opening and stopping valves to monitor fluid flow. No matter the perioperative scrubbing, bacterial transmission remains a risk with manual CSF drainage. Bacterial transfer during surgery occurs via respiratory droplets, skin scales carried in the air, and inadvertent contact with surgeon and nurse skin.
  3. Quick mobility – For patients undergoing TAAA open repair, rapid mobility after surgery is a critical aspect of recovery. Gentle movement supports adequate respiratory and vascular function.An automated system’s alarm features actually provide patients with more freedom to move as they and hospital staff know that adequate CSF pressure is constantly monitored. Manual CSF drainage, on the other hand, requires the patient to remain still, lying on their back. With the automated system’s transducer set at the first connection that works with a closed circuit, the patient can even change position in bed. These alarms allow patients to quickly become accustomed to how much movement is safe.
  4. Lower Risk of intracranial hypotension leading to “spinal headache” – Up to 9.7% of patients experience spinal headache after TAAA because of the stretching of the sensory receptors in the dural sinuses. Pain can linger for up to 8 days. When this “puncture headache” limits patient mobilization, outcomes deteriorate. A 2017 study of 152 patients conducted at the vascular surgery unit at San Raffaele Scientific Institute found that the use of Moeller Medical’s automated CSF drainage system LiquoGuard® resulted in reduced likelihood of spinal headache than in patients that used manual CSF drainage. Researchers also concluded, “perioperative use of the LiquoGuard during TAAA open repair was safe and effective.”

The Most Modern, Effective Approach to CSF Management

Your hospital or surgery suite can create a safer, less stressful environment by adopting German-engineered, precision cerebrospinal fluid drainage equipment. Our most current iteration, LiquoGuard® 7, maximizes drainage safety, quickly allows patients more mobility, and even reduces treatment costs. It is the only CSF management system in the world that simultaneously drains and measures CSF pressure.

Vascular Surgeon and Professor Stephen Haulon of the Aortic Centre Hôpital Marie Lannelongue Université Paris Sud, has been using LiquoGuard® 7 for years. He depends on this specialized equipment because,

“CSF drainage has become a safe adjunct to our complex aortic repairs since we have started using routinely the LiquoGuard® 7 system. It is a mandatory tool in the armamentarium to prevent spinal cord ischemia, and the very accurate monitoring of pressure and volumes reduces the risks associated with CSF drainage. ”

Read more about Dr. Haulon’s experience with our LiquoGuard® 7 here.