Article Figures & Data
- Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart showing the study selection process.
- Figure 2
Pooled ORs comparing combined cisternal irrigation to conventional therapy. (A) Mortality, (B) functional outcome, (C) delayed cerebral ischaemia and (D) cerebral vasospasm. RCT, randomised controlled trial.
- Figure 3
Pooled ORs comparing fibrinolytic cisternal irrigation to conventional therapy. (A) Mortality, (B) functional outcome, (C) delayed cerebral ischaemia and (D) cerebral vasospasm. FCI, fibrinolytic cisternal irrigation; RCT, randomised controlled trial.
- Figure 4
Pooled ORs comparing vasodilatory cisternal irrigation to treatment without vasodilatory cisternal irrigation. (A) Mortality, (B) functional outcome, (C) cerebral vasospasm. RCT, randomised controlled trial; VCI, vasodilatory cisternal irrigation.
- Table 1
Summary of findings and GRADE assessment
Cisternal irrigation overall compared with conventional treatment for subarachnoid haemorrhage13–22 Outcomes Participants (studies) (n) Certainty of the evidence (GRADE) Relative effect
OR (95% CI)Anticipated absolute effects Risk with conventional treatment per 1000 Risk difference with combined irrigation per 1000 (95% CI)
ref. ConventionalFavourable outcome 1113
(2 RCTs, 5 observational)⨁⨁⨁⨁
High1.83
(1.35 to 2.48)523 144
(74 to 208)Mortality 1858
(2 RCTs, 8 observational)⨁⨁⨁⨁
High0.65
(0.45 to 0.94)189 −57
(−94 to −9)DCI 1237
(1 RCT, 6 observational)⨁⨁◯◯
Low0.33
(0.19 to 0.58)251 −152
(−191 to −88)Cerebral vasospasm 1075
(1 RCT, 5 observational)⨁⨁◯◯
Low0.32
(0.20 to 0.51)403 −225
(−284 to −147)Fibrinolytic cisternal irrigation vs conventional treatment for subarachnoid haemorrhage 14–16 18–22 Outcomes Participants (studies) (n) Certainty of the evidence (GRADE) Relative effect OR (95% CI) Anticipated absolute effects Risk with conventional treatment per 1000 Risk difference with fibrinolytic irrigation per 1000 (95% CI)
ref. ConventionalFavourable outcome 1031
(2 RCTs, 4 observational)⨁⨁⨁⨁
High1.80
(1.30 to 2.51)536 139
(64 to 207)Mortality 1715
(2 RCTs, 6 observational)⨁⨁⨁⨁
High0.68
(0.46 to 1.00)182 −51
(−89 to 0)DCI 1176
(1 RCT, 5 observational)⨁⨁⨁⨁
High0.28
(0.18 to 0.42)248 −163
(−192 to −126)Cerebral vasospasm 974
(1 RCT, 4 observational)⨁⨁⨁⨁
High0.28
(0.18 to 0.42)381 −234
(−281 to −175)Vasodilatory cisternal irrigation vs no vasodilatory cisternal irrigation for subarachnoid haemorrhage 13 18 23 24 Outcomes Participants (studies) (n) Certainty of the evidence (GRADE) Relative effect OR (95% CI) Anticipated absolute effects Risk with no vasodilatory irrigation per 1000 Risk difference with vasodilatory irrigation per 1000 (95% CI)
ref. No vasodilatory irrigationFavourable outcome 317
(3 RCTs, 1 observational)⨁⨁◯◯
Low2.03
(0.97 to 4.26)651 140
(−7 to 237)Mortality 317
(3 RCTs, 1 observational)⨁⨁⨁◯
Moderate0.32
(0.13 to 0.79)171 −109
(−145 to −31)DCI 70
(1 RCT)⨁◯◯◯
Very low0.48
(0.14 to 1.62)257 −115
(−211 to 102)Cerebral vasospasm 275
(3 RCTs)⨁◯◯◯
Very low0.37
(0.17 to 0.79)338 −179
(−258 to −51)DCI, delayed cerebral ischaemia; GRADE, Grading of Recommendations, Assessment, Development and Evaluations; RCT, randomised controlled trial.
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