• Joshua Stephen Catapano, John Hawryluk Gregory William GW Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA; Brain and Spinal Cord Injury Center, University of California,, William Whetstone, Rajiv Saigal, Adam Ferguson, Jason Talbott, Jacqueline Bresnahan, Sanjay Dhall, Jonathan Pan, Michael Beattie, and Geoffrey Manley.
• Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
• World Neurosurg. 2016 Dec 1; 96: 72-79.

BackgroundTraumatic 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.ObjectiveTo assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score.MethodsHigh-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.ResultsSixty-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.ConclusionA 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 © 2016 Elsevier Inc. All rights reserved.

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