Interventions to Optimize Spinal Cord Perfusion in Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review

Global Spine Journal, 2024 · DOI: 10.1177/21925682231218737 · Published: March 1, 2024

Spinal Cord Injury Cardiovascular Science Trauma

Simple Explanation

This study investigates methods to improve blood flow to the spinal cord after a traumatic injury, aiming to reduce further damage and enhance recovery. The review analyzes existing research on maintaining specific blood pressure targets (MAP and SCPP) and their effects on patient outcomes. The study updates a previous review with new data, assessing various techniques, perfusion ranges, drugs, and treatment durations to provide evidence for clinical practice guidelines.

Study Duration

Not specified

Participants

28 studies (total n = 1528) including 9 new studies, consisting of RCTs and observational studies.

Evidence Level

Systematic Review

Key Findings

1
The effect of MAP support on neurological recovery remains uncertain based on very low-quality evidence from observational studies.
2
MAP support via vasopressors may be associated with increased rates of cardiac arrhythmias, myocardial injury, acidosis, and skin necrosis.
3
Increased SCPP may be associated with improved neurological recovery, though the evidence is of very low quality.

Research Summary

This updated systematic review assesses interventions to optimize spinal cord perfusion in acute traumatic SCI patients, incorporating nine new studies into a previous review. The review finds only low or very low-quality evidence regarding the relationship between MAP or SCPP support and neurological recovery, and potential risks of adverse events. The literature lacks clear guidance on specific monitoring techniques, perfusion ranges, pharmacological agents, or treatment durations for optimizing spinal cord perfusion.

Practical Implications

Clinical Practice Guideline Development

The evidence base supports the development of clinical practice guidelines, but the low quality of evidence suggests strong recommendations may not be warranted.

Varied Management Approaches

Approaches to hemodynamic management could reasonably vary across different clinical scenarios due to the uncertainty in the evidence.

Future Research Priorities

Further high-quality studies are needed to examine interventions to optimize spinal cord perfusion after acute traumatic SCI.

Study Limitations

1
Low or very low quality evidence limits the confidence in the estimates of effects.
2
Studies failed to directly compare interventions and control for selection bias.
3
Failure to control for heterogeneity due to anatomical level and neurological severity of patient’s injuries.

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