Expanding the Role of Active Irrigation in Neurocritical Care: A Case Series with IRRAflow and Review of Current Literature

Introduction: Active fluid management systems have emerged to address limitations of standard external drains in neurosurgery. IRRAflow (IRRAS AB) is a dual-lumen automated irrigation and drainage catheter system that can intermittently infuse fluid and aspirate cerebrospinal fluid (CSF) in a closed circuit. Background: Conventional external ventricular drains (EVDs) are lifesaving for acute hydrocephalus, but they have notable drawbacks. These challenges underscore the need for improved CSF drainage techniques and targeted intrathecal therapies. IRRAflow’s continuous irrigation capability permits direct delivery of therapeutic agents, such as antibiotics or fibrinolytics, into the CSF, while its active drainage may reduce stagnation of blood clots or purulent fluid Methods: We conducted a systematic review of the literature across three databases on IRRAflow-based treatments for SDH, IVH, and ventriculitis. Additionally, we retrospectively analyzed 13 consecutive patients treated at our institution meeting inclusion criteria of radiologically confirmed pathology and catheter-based intervention. Outcomes were compared descriptively with data from the literature. Conclusion: Our institutional outcomes align with published data but highlight the need for clearer protocols to improve consistency and results.