scholarly journals Initial Experience of Spinal Cord Perfusion Pressure Goals in Lieu of Mean Arterial Pressure Goals in Acute Traumatic Spinal Cord Injury at a United States Level I Trauma Center: A Transforming Research and Clinical Knowledge-Spinal Cord Injury Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
John K Yue ◽  
Debra P Hemmerle ◽  
Hansen Deng ◽  
Ethan A Winkler ◽  
Leigh H Thomas ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
Perfusion Pressure ◽  
Standard Of Care ◽  
Traumatic Spinal Cord Injury ◽  
Initial Experience ◽  
Clinical Knowledge ◽  
Cord Injury ◽  
Level I

Abstract INTRODUCTION Management of traumatic spinal cord injury (SCI) includes urgent decompression and decreasing secondary injury through blood pressure augmentation. Mean arterial pressure (MAP) targets have been the standard of care for decades, however recent clinical trial data have demonstrated the relationship between spinal cord perfusion pressure (SCPP) and neurologic recovery. These data led to implementation of a novel standard of care protocol at our institution focused on SCPP, in lieu of MAP goals. We provide the initial experience of implementation of protocolized SCPP goals for acute SCI at a US level I trauma center. METHODS Starting December 2017, all moderate/severe blunt SCI patients at our institution presenting < 24 h of injury received lumbar subarachnoid drain placement (LSAD) for intraspinal pressure (ISP) and SCPP monitoring in the neurological intensive care unit (NICU), and were included in the Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) data registry. This is known as the SCPP Protocol, and comprises standard care at our institution. SCPPs were monitored for 5 d with goal = 65 mmHg achieved through intravenous fluids and vasopressor support. American Spinal Injury Association Impairment Scale (AIS) grades were assessed at admission and day 7. RESULTS In 15 patients enrolled to date, age was 60.5 ± 17.0 yr and 46.7% were = 65. Injury level was 93.3% cervical and 6.7% thoracic. Admission AIS were 20.0%/20.0%/26.7%/33.3% for A/B/C/D, respectively. A total of 14 patients underwent surgical decompression with time to surgery 8.8 ± 7.1 h and 71.4% < 12 h. Hospital length of stay (LOS) was 14.7 ± 8.3 d. NICU LOS was 11.5 ± 8.9 d. No patient had lumbar drain-related complications. Seven patients had respiratory complications and 1 expired after family transitioned to comfort care. AIS grade improvement of 1 occurred in one-third of patients (2 AIS = B, 3 AIS = C). CONCLUSION In our initial experience of 15 patients with acute traumatic SCI, standardized SCPP goal-directed care through lumbar ISP monitoring for the first 5 d postinjury was feasible and without SCPP-related complications.

scholarly journals Clinical Implementation of Novel Spinal Cord Perfusion Pressure Protocol in Acute Traumatic Spinal Cord Injury at U.S. Level I Trauma Center: TRACK-SCI Study

2020 ◽  
Vol 133 ◽  
pp. e391-e396 ◽  
Author(s):  
John K. Yue ◽  
Debra D. Hemmerle ◽  
Ethan A. Winkler ◽  
Leigh H. Thomas ◽  
Xuan Duong Fernandez ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
Perfusion Pressure ◽  
Traumatic Spinal Cord Injury ◽  
Clinical Implementation ◽  
Cord Injury ◽  
Level I ◽  
Center Track

The Incidence of Neurogenic Shock after Spinal Cord Injury in Patients Admitted to a High-Volume Level I Trauma Center

2012 ◽  
Vol 78 (5) ◽  
pp. 623-626 ◽  
Author(s):  
Jennifer T. Mallek ◽  
Kenji Inaba ◽  
Bernardino C. Branco ◽  
Crystal Ives ◽  
Lydia Lam ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
High Volume ◽  
Neurogenic Shock ◽  
Cord Injury ◽  
Volume Level ◽  
Level I

scholarly journals The Effects of Trauma Center Care, Admission Volume, and Surgical Volume on Paralysis After Traumatic Spinal Cord Injury

2009 ◽  
Vol 249 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Carlos Aitor Macias ◽  
Matthew R. Rosengart ◽  
Juan-Carlos Puyana ◽  
Walter T. Linde-Zwirble ◽  
Wade Smith ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
Traumatic Spinal Cord Injury ◽  
Surgical Volume ◽  
Cord Injury ◽  
Center Care

Acute, severe traumatic spinal cord injury: improving urinary bladder function by optimizing spinal cord perfusion

2021 ◽  
pp. 1-8
Author(s):  
Florence R. A. Hogg ◽  
Siobhan Kearney ◽  
Eskinder Solomon ◽  
Mathew J. Gallagher ◽  
Argyro Zoumprouli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Urinary Bladder ◽  
Perfusion Pressure ◽  
Bladder Function ◽  
Traumatic Spinal Cord Injury ◽  
Injury Site ◽  
Bladder Compliance ◽  
Cord Injury

OBJECTIVE The authors sought to investigate the effect of acute, severe traumatic spinal cord injury on the urinary bladder and the hypothesis that increasing the spinal cord perfusion pressure improves bladder function. METHODS In 13 adults with traumatic spinal cord injury (American Spinal Injury Association Impairment Scale grades A–C), a pressure probe and a microdialysis catheter were placed intradurally at the injury site. We varied the spinal cord perfusion pressure and performed filling cystometry. Patients were followed up for 12 months on average. RESULTS The 13 patients had 63 fill cycles; 38 cycles had unfavorable urodynamics, i.e., dangerously low compliance (< 20 mL/cmH2O), detrusor overactivity, or dangerously high end-fill pressure (> 40 cmH2O). Unfavorable urodynamics correlated with periods of injury site hypoperfusion (spinal cord perfusion pressure < 60 mm Hg), hyperperfusion (spinal cord perfusion pressure > 100 mm Hg), tissue glucose < 3 mM, and tissue lactate to pyruvate ratio > 30. Increasing spinal cord perfusion pressure from 67.0 ± 2.3 mm Hg (average ± SE) to 92.1 ± 3.0 mm Hg significantly reduced, from 534 to 365 mL, the median bladder volume at which the desire to void was first experienced. All patients with dangerously low average initial bladder compliance (< 20 mL/cmH2O) maintained low compliance at follow-up, whereas all patients with high average initial bladder compliance (> 100 mL/cmH2O) maintained high compliance at follow-up. CONCLUSIONS We conclude that unfavorable urodynamics develop within days of traumatic spinal cord injury, thus challenging the prevailing notion that the detrusor is initially acontractile. Urodynamic studies performed acutely identify patients with dangerously low bladder compliance likely to benefit from early intervention. At this early stage, bladder function is dynamic and is influenced by fluctuations in the physiology and metabolism at the injury site; therefore, optimizing spinal cord perfusion is likely to improve urological outcome in patients with acute severe traumatic spinal cord injury.

scholarly journals Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

2019 ◽  
Vol 10 (03) ◽  
pp. 393-399
Author(s):  
Ayodeji Salman Yusuf ◽  
Muhammad Raji Mahmud ◽  
Dumura Jeneral Alfin ◽  
Samue Isa Gana ◽  
Samaila Timothy ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Trauma Center ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Prehospital Care ◽  
Insurance Coverage ◽  
Traumatic Spinal Cord Injury ◽  
Optimal Care ◽  
Cord Injury

Abstract Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods  This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.

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