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Malomo, Toluyemi Adefolarin

University of British Columbia

Background: Prior to the release of the 2024 management guidelines for spinal cord injury (SCI), previous guidelines suggested augmenting the systemic mean arterial pressure (MAP) to a target of 85-90mmHg for the first 7 days after injury. Although this may improve blood flow to the injured cord and reduce ischemia, it could cause an inadvertent increase in intraparenchymal hemorrhage (IPH). This study aims to assess the impact of MAP augmentation and venous thromboembolism (VTE) prophylaxis on IPH progression after acute human SCI. Methods: In SCI patients, Norepinephrine alone or in conjunction with Vasopressin was used to keep MAP between 85-90 mmHg. Magnetic Resonance Imaging (MRI) was done on admission (within 24 hours post-SCI) and on days 2, 4, 7, and 14 post-injury. Hemorrhage was quantified on T2-weighted MRI scans. Hemorrhage progression (Delta IPH or ΔIPH) was determined by calculating the difference between the hemorrhage volume on the baseline MRI and at other time points. The cumulative MAP exposure is the Time-Weighted Average MAP (TWA-MAP), which was calculated by dividing the area under the curve of the MAP measurements by the total hours of exposure. Regression (simple and multivariate) and linear mixed effect model analysis were used to explore the relationship between Delta IPH and TWA-MAP and the factors influencing hemorrhage progression after SCI. Results: Data from 13 patients were analyzed. While IPH progressively increased on days 2 and 4, it decreased from day 7. TWA-MAP was significantly associated with Delta IPH p=<0.0001 during the first two days following SCI. The baseline IPH was the most significant predictor of hemorrhage progression from the time of injury to days 2 and 4 post-trauma. From days 2 to 4 post-trauma, TWA-MAP was the most important predictor of hemorrhage progression. The time to initiation of VTE and Norepinephrine dose did not affect hemorrhage progression. Conclusions: There is a positive correlation between MAP exposure and hemorrhage progression after SCI, more evident with severe IPH at baseline. Hence, harmful bleeding within the spinal cord may be a contributing factor to the difficulty of establishing the effectiveness of maintaining MAP above 85 mmHg for neurological recovery.

Text; Still Image

2025-03-04

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/90454

Neuroscience

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/