• John K Yue, Debra D Hemmerle, Ethan A Winkler, Leigh H Thomas, Xuan Duong Fernandez, Nikolaos Kyritsis, Jonathan Z Pan, Lisa U Pascual, Vineeta Singh, Philip R Weinstein, Jason F Talbott, Huie J Russell JR Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco G, Adam R Ferguson, William D Whetstone, Geoffrey T Manley, Michael S Beattie, Jacqueline C Bresnahan, Praveen V Mummaneni, and Sanjay S Dhall.
• Department of Neurological Surgery, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
• World Neurosurg. 2020 Jan 1; 133: e391-e396.

ObjectiveWe sought to report the safety of implementation of a novel standard of care protocol using spinal cord perfusion pressure (SCPP) maintenance for managing traumatic spinal cord injury (SCI) in lieu of mean arterial pressure goals at a U.S. Level I trauma center.MethodsStarting in December 2017, blunt SCI patients presenting <24 hours after injury with admission American Spinal Injury Association Impairment Scale (AIS) A-C (or AIS D at neurosurgeon discretion) received lumbar subarachnoid drain (LSAD) placement for SCPP monitoring in the intensive care unit and were included in the TRACK-SCI (Transforming Research and Clinical Knowledge in Spinal Cord Injury) data registry. This SCPP protocol comprises standard care at our institution. SCPPs were monitored for 5 days (goal ≥65 mm Hg) achieved through intravenous fluids and vasopressor support. AISs were assessed at admission and day 7.ResultsFifteen patients enrolled to date were aged 60.5 ± 17 years. Injury levels were 93.3% (cervical) and 6.7% (thoracic). Admission AIS was 20.0%/20.0%/26.7%/33.3% for A/B/C/D. All patients maintained mean SCPP ≥65 mm Hg during monitoring. Fourteen of 15 cases required surgical decompression and stabilization with time to surgery 8.8 ± 7.1 hours (71.4% <12 hours). At day 7, 33.3% overall and 50% of initial AIS A-C had an improved AIS. Length of stay was 14.7 ± 8.3 days. None had LSAD-related complications. There were 7 respiratory complications. One patient expired after transfer to comfort care.ConclusionsIn our initial experience of 15 patients with acute SCI, standardized SCPP goal-directed care based on LSAD monitoring for 5 days was feasible. There were no SCPP-related complications. This is the first report of SCPP implementation as clinical standard of care in acute SCI.Copyright © 2019 Elsevier Inc. All rights reserved.

36 keywords...

hide…