Joshua Stephen Catapano1, Gregory William John Hawryluk2, William Whetstone3, Rajiv Saigal4, Adam Ferguson5, Jason Talbott6, Jacqueline Bresnahan5, Sanjay Dhall5, Jonathan Pan7, Michael Beattie5, Geoffrey Manley5. 1. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA. 2. Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA; Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA. Electronic address: gregory.hawryluk@hsc.utah.edu. 3. Department of Emergency Medicine, University of California, San Francisco, California, USA. 4. Department of Neurosurgery, University of Washington, Seattle, Washington, USA. 5. Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA. 6. Department of Radiology, University of California, San Francisco, California, USA. 7. Department of Anaesthesia, University of California, San Francisco, California, USA.
Abstract
BACKGROUND: Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mm Hg for 7 days following SCI to minimize spinal cord ischemia. Some physicians doubt that patients with initially complete injuries benefit. OBJECTIVE: To assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score. METHODS: High-frequency MAP values of acute SCI patients admitted over a 6-year period were recorded, and values were correlated with degree of neurologic recovery in an analysis stratified by postresuscitation AIS score. RESULTS: Sixty-two patients with SCI were analyzed. Thirty-three patients were determined to have complete injuries, and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 ± 0.07 mm Hg vs. 94.4 ± 0.06 mm Hg, respectively; P < 0.001), and the proportion of MAP values <85 mm Hg was significantly lower (13.5% vs. 25.6%, respectively; P < 0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients but was not observed in patients who were initially AIS D. CONCLUSION: A positive correlation was observed between MAP values and neurologic recovery in AIS A, B, and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries. Copyright Â
BACKGROUND:Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mm Hg for 7 days following SCI to minimize spinal cord ischemia. Some physicians doubt that patients with initially complete injuries benefit. OBJECTIVE: To assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score. METHODS: High-frequency MAP values of acute SCI patients admitted over a 6-year period were recorded, and values were correlated with degree of neurologic recovery in an analysis stratified by postresuscitation AIS score. RESULTS: Sixty-two patients with SCI were analyzed. Thirty-three patients were determined to have complete injuries, and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 ± 0.07 mm Hg vs. 94.4 ± 0.06 mm Hg, respectively; P < 0.001), and the proportion of MAP values <85 mm Hg was significantly lower (13.5% vs. 25.6%, respectively; P < 0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients but was not observed in patients who were initially AIS D. CONCLUSION: A positive correlation was observed between MAP values and neurologic recovery in AIS A, B, and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries. Copyright Â
Authors: Daniel De Backer; Patrick Biston; Jacques Devriendt; Christian Madl; Didier Chochrad; Cesar Aldecoa; Alexandre Brasseur; Pierre Defrance; Philippe Gottignies; Jean-Louis Vincent Journal: N Engl J Med Date: 2010-03-04 Impact factor: 91.245
Authors: Constantin Popa; Florian Popa; Valentin Titus Grigorean; Gelu Onose; Aurelia Mihaela Sandu; Mihai Popescu; Gheorghe Burnei; Victor Strambu; Crina Sinescu Journal: J Med Life Date: 2010 Jul-Sep
Authors: Ryan Hirschi; Gregory W J Hawryluk; Jessica L Nielson; J Russell Huie; Lara L Zimmermann; Rajiv Saigal; Quan Ding; Adam R Ferguson; Geoffrey Manley Journal: J Neurosurg Date: 2018-10-01 Impact factor: 5.115
Authors: Stephen J Lewis; Ian H Y Wong; Samuel Strantzas; Laura M Holmes; Ian Vreugdenhil; Hailey Bensky; Christopher J Nielsen; Reinhard Zeller; David E Lebel; Marinus de Kleuver; Niccole Germscheid; Ahmet Alanay; Sigurd Berven; Kenneth M C Cheung; Manabu Ito; David W Polly; Christopher I Shaffrey; Yong Qiu; Lawrence G Lenke Journal: Global Spine J Date: 2019-05-08
Authors: Reza Ehsanian; Jenny Haefeli; Nhung Quach; Jacob Kosarchuk; Dolores Torres; Ellen D Stuck; Jessica Endo; James D Crew; Benjamin Dirlikov; Jacqueline C Bresnahan; Michael S Beattie; Adam R Ferguson; Stephen L McKenna Journal: Spinal Cord Date: 2019-10-24 Impact factor: 2.772
Authors: Carlos A Almeida; Abel Torres-Espin; J Russell Huie; Dongming Sun; Linda J Noble-Haeusslein; Wise Young; Michael S Beattie; Jacqueline C Bresnahan; Jessica L Nielson; Adam R Ferguson Journal: Neuroinformatics Date: 2021-03-02
Authors: Joe Fenn; Hongyu Ru; Nick D Jeffery; Sarah Moore; Andrea Tipold; Franz J Soebbeler; Adriano Wang-Leandro; Christopher L Mariani; Peter J Early; Karen R Muñana; Natasha J Olby Journal: J Vet Intern Med Date: 2020-05-17 Impact factor: 3.333