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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.
Yue, John K; Hemmerle, Debra D; Winkler, Ethan A; Thomas, Leigh H; Fernandez, Xuan Duong; Kyritsis, Nikolaos; Pan, Jonathan Z; Pascual, Lisa U; Singh, Vineeta; Weinstein, Philip R; Talbott, Jason F; Huie, J Russell; Ferguson, Adam R; Whetstone, William D; Manley, Geoffrey T; Beattie, Michael S; Bresnahan, Jacqueline C; Mummaneni, Praveen V; Dhall, Sanjay S.
Afiliación
  • Yue JK; 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.
  • Hemmerle DD; 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.
  • Winkler EA; 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.
  • Thomas LH; 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.
  • Fernandez XD; 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.
  • Kyritsis N; 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.
  • Pan JZ; Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
  • Pascual LU; Department of Rehabilitation Medicine, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
  • Singh V; Department of Neurology, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
  • Weinstein PR; Department of Neurological Surgery, University of California, San Francisco, California, USA.
  • Talbott JF; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
  • Huie JR; 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.
  • Ferguson AR; 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.
  • Whetstone WD; Department of Emergency Medicine, University of California, San Francisco, California, USA; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
  • Manley GT; 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.
  • Beattie MS; 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.
  • Bresnahan JC; 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.
  • Mummaneni PV; Department of Neurological Surgery, University of California, San Francisco, California, USA.
  • Dhall SS; 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. Electronic address: sanjaydhall@gmail.com.
World Neurosurg ; 133: e391-e396, 2020 Jan.
Article en En | MEDLINE | ID: mdl-31526882
ABSTRACT

OBJECTIVE:

We 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.

METHODS:

Starting 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.

RESULTS:

Fifteen 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.

CONCLUSIONS:

In 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.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Presión del Líquido Cefalorraquídeo / Nivel de Atención Tipo de estudio: Guideline Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2020 Tipo del documento: Article
Texto completo
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Traumatismos de la Médula Espinal / Presión del Líquido Cefalorraquídeo / Nivel de Atención Tipo de estudio: Guideline Idioma: En Revista: World Neurosurg Asunto de la revista: NEUROCIRURGIA Año: 2020 Tipo del documento: Article