Hemodynamic Management of Acute Spinal Cord Injury: A Literature Review

Abstract

The goal of acute spinal cord injury (SCI) management is to reduce secondary injuries and improve neurological recovery after its occurrence. This review aimed to explore the literature regarding hemodynamic management to reduce ischemic secondary injury and improve neurologic outcome following acute SCI. The PubMed database was searched for studies investigating blood flow, mean arterial pressure (MAP), and spinal cord perfusion pressure after SCI. The 2013 guidelines of the American Association of Neurological Surgeons/Congress of Neurological Surgeons recommended maintaining MAP at 85-90 mmHg for 7 days after SCI to potentially improve outcome. However, this recommendation was based on weak evidence for neurologic benefit. The maintenance of MAP will typically require vasopressors, which may have their own set of complications. More recently, studies have suggested the potential importance of considering spinal cord perfusion pressure in addition to the MAP. Further research on the hemodynamic management of acute SCI is required to determine how to optimize neurologic recovery. Evidence-based guidelines for hemodynamic management should acknowledge the gaps in knowledge and the limitations of the current literature.

Keywords: Hemodynamic management; Mean arterial pressure; Spinal cord injury; Spinal cord perfusion pressure.

Fig. 1.

Spinal pressure reactivity index (sPRx) is needed to determine the optimal mean arterial pressure (MAP) in spinal cord injury patients and animal models. When sPRx < 0.3, spinal autoregulation is performed, so the MAP at this time becomes the optimal MAP. Accordingly, sPRx can be measured to determine the optimal MAP during spinal cord injury treatment.