Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury

Squair, Jordan W.; Bélanger, Lise; Tsang, Angela; Ritchie, Leanna; Mac-Thiong, Jean-Marc; Parent, Stefan; Christie, Sean; Bailey, Chris; Dhall, Sanjay S.; Street, John; Ailon, Tamir; Paquette, Scott; Dea, Nicolas; Fisher, Charles G.; Dvorak, Marcel F.; West, Christopher R.; Kwon, Brian K.

doi:10.1212/wnl.0000000000004519

Cited by 134 publications

(113 citation statements)

References 18 publications

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“…; Squair et al . ). To investigate the severity of orthostatic intolerance in the present study, we conducted head‐up tilt testing both pre‐ and post‐SCI.…”

Section: Discussionmentioning

confidence: 97%

“…This is especially pertinent not only for the maintenance of appropriate haemodynamics but also because mean arterial pressure, along with changes in cerebrospinal fluid pressure (Squair et al . ), are known to influence spinal cord perfusion pressure and therefore neurological recovery (Hawryluk et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…In the acute clinical setting, the incidence and severity of orthostatic intolerance is less clear as often the patients most at risk of orthostatic intolerance due to their injury level (i.e. those with cervical or high-thoracic SCI) are being treated with vasopressors with a view to maintaining spinal cord perfusion (Hawryluk et al 2015;Squair et al 2017a). To investigate the severity of orthostatic intolerance in the present study, we conducted head-up tilt testing both pre-and post-SCI.…”

Section: Acute Study: Response To Head-up Tiltmentioning

confidence: 99%

“…This lack of knowledge on the immediate cardiovascular responses to acute SCI is particularly troubling as cardiovascular complications in this setting are often thought to be life-threatening (Grigorean et al 2009), and may impair spinal cord blood flow, thereby subjecting the traumatically injured spinal cord to additional ischaemic insults. Conversely, appropriate cardiovascular management can provide neuroprotection to the injured cord by supporting adequate spinal cord perfusion, ultimately improving neurological outcomes in patients (Hawryluk et al 2015;Squair et al 2017a).…”

Section: Introductionmentioning

confidence: 99%

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A porcine model for studying the cardiovascular consequences of high‐thoracic spinal cord injury

West

Poormasjedi‐Meibod

Manouchehri

et al. 2020

The Journal of Physiology

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Key points We have developed a novel porcine model of high‐thoracic midline contusion spinal cord injury (SCI) at the T2 spinal level. We describe this model and the ensuing cardiovascular and neurohormonal responses, and demonstrate the model is efficacious for studying clinically relevant cardiovascular dysfunction post‐SCI. We demonstrate that the high‐thoracic SCI model, but not a low‐thoracic SCI model, induces persistent hypotension along with a gradual reduction in plasma noradrenaline and increases in plasma aldosterone and angiotensin II. We additionally conducted a proof‐of‐concept long‐term (12 weeks) survival study in animals with T2 contusion SCI demonstrating the potential utility of this model for not only acute experimentation but also long‐term drug studies prior to translation to the clinic. Abstract Cardiovascular disease is a leading cause of morbidity and mortality in the spinal cord injury (SCI) population, especially in those with high‐thoracic or cervical SCI. With this in mind, we aimed to develop a large animal (porcine) model of high‐thoracic (T2 level) contusion SCI and compare the haemodynamic and neurohormonal responses of this injury against a low‐thoracic (T10 level) model. Ten Yorkshire pigs were randomly subjected to 20 cm weight drop contusion SCI at either the T2 or the T10 spinal level. Systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) were continuously monitored until 4 h post‐SCI. Plasma noradrenaline (NA), aldosterone and angiotensin II (ANGII) were measured pre‐SCI and at 30, 60, 120 and 240 min post‐SCI. Additionally, two Yucatan pigs were subjected to T2‐SCI and survived up to 12 weeks post‐injury to demonstrate the efficacy of this model for long‐term survival studies. Immediately after T2‐SCI, SBP, MAP and HR increased (P < 0.0001). Between decompression (5 min post‐SCI) and 30 min post‐decompression in T2‐SCI, SBP and MAP were lower than pre‐SCI (P < 0.038). At 3 and 4 h after T2‐SCI, SBP remained lower than pre‐SCI (P = 0.048). After T10‐SCI, haemodynamic indices remained largely unaffected. Plasma NA was lower in T2‐ vs. T10‐SCI post‐SCI, whilst aldosterone and ANGII were higher. Both chronically injured pigs demonstrated a vast reduction in SBP at 12 weeks post‐SCI. Our model of T2‐SCI causes a rapid and sustained alteration in neurohormonal control and cardiovascular function, which does not occur in the T10 model.

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“…; Squair et al . ). To investigate the severity of orthostatic intolerance in the present study, we conducted head‐up tilt testing both pre‐ and post‐SCI.…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Acute Study: Response To Head-up Tiltmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A porcine model for studying the cardiovascular consequences of high‐thoracic spinal cord injury

West

Poormasjedi‐Meibod

Manouchehri

et al. 2020

The Journal of Physiology

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“…Since clinical features do not accurately predict SCPP opt , invasive ISP monitoring remains the only way of determining SCPP opt . A recent study showed that SCPP can be calculated by monitoring CSF pressure using a lumbar catheter and that SCPP measured in this way better correlates with outcome than MAP [30]. Monitoring CSF pressure is less invasive than monitoring ISP.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

et al. 2018

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Background/ObjectivesWe recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPPopt) in patients with acute traumatic spinal cord injury (TSCI). We hypothesized that ISP and SCPPopt can be predicted using clinical factors instead of ISP monitoring.MethodsSixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. For 24 h after surgery, we monitored ISP and SCPP and computed SCPPopt (SCPP that optimizes pressure reactivity). We studied how well 28 factors correlate with mean ISP or SCPPopt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors.ResultsAll patients underwent surgery to restore normal spinal alignment within 72 h of injury. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPPopt to be computed. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPPopt could not be calculated. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. Only 2/28 factors correlated with lower SCPPopt: higher mean ISP and conus medullaris injury. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPPopt as low, medium–low, medium–high, or high with only 42% accuracy. No MRI factors correlated with ISP or SCPPopt.ConclusionsElevated ISP can be predicted by clinical factors. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. No factors accurately predict SCPPopt; thus, invasive monitoring remains the only way to estimate SCPPopt.Electronic supplementary materialThe online version of this article (10.1007/s12028-018-0616-7) contains supplementary material, which is available to authorized users.

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Monitoring Tissue Perfusion

Nectoux¹,

Hoareau²

2023

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

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Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury

Cited by 134 publications

References 18 publications

A porcine model for studying the cardiovascular consequences of high‐thoracic spinal cord injury

A porcine model for studying the cardiovascular consequences of high‐thoracic spinal cord injury

Predictors of Intraspinal Pressure and Optimal Cord Perfusion Pressure After Traumatic Spinal Cord Injury

Monitoring Tissue Perfusion

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