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The acute phase management of spinal cord injury affecting polytrauma patients : the ASAP study
Authors
Fikri Abu-Zidan
Luca Ansaloni
+43 more
Marta Velia Antonini
Zsolt J. Balogh
Solomon Gurmu Beka
Walter L. Biffl
Fausto Catena
Luca Cattani
Marco Ceresoli
Osvaldo Chiara
Mircea Chirica
Federico Coccolini
Raul Coimbra
Yunfeng Cui
Belinda De Simone
Salomone Di Saverio
Francesco Domenichelli
Gustavo P. Fraga
Joseph M. Galante
Deepak Gupta
Andreas Hecker
Corrado Iaccarino
Andrew W. Kirkpatrick
Ari Leppaniemi
Andrey Litvin
Ronald V. Maier
Laura Malchiodi
Ingo Marzi
Francesco Minardi
Vito Montanaro
Massimo Petranca
Edoardo Picetti
Sandro Rizoli
Chiara Robba
Sandra Rossi
Emanuele Sani
Massimo Sartelli
Franco Servadei
Vishal G. Shelat
Philip F. Stahel
Fabio S. Taccone
Edward Tan
Giovanni D. Tebala
Andreas W. Unterberg
Imtiaz Wani
Publication date
1 January 2022
Publisher
Doi
Cite
Abstract
Publisher Copyright: © 2022, The Author(s).Background: Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. Methods: The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. Results: There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80–90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80–100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35–40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. Conclusions: Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.Peer reviewe
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eScholarship - University of California
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Helsingin yliopiston digitaalinen arkisto
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Last time updated on 17/05/2022