The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

Springer Science and Business Media LLC - Tập 17 - Trang 1-14 - 2022
Edoardo Picetti1, Corrado Iaccarino2, Raul Coimbra3,4, Fikri Abu-Zidan5, Giovanni D. Tebala6, Zsolt J. Balogh7,8, Walter L. Biffl9, Federico Coccolini10, Deepak Gupta11, Ronald V. Maier12, Ingo Marzi13, Chiara Robba14,15, Massimo Sartelli16, Franco Servadei17,18, Philip F. Stahel19,20, Fabio S. Taccone21, Andreas W. Unterberg22, Marta Velia Antonini23,2, Joseph M. Galante24, Luca Ansaloni25, Andrew W. Kirkpatrick26, Sandro Rizoli27, Ari Leppaniemi28, Osvaldo Chiara29, Belinda De Simone30, Mircea Chirica31, Vishal G. Shelat32, Gustavo P. Fraga33, Marco Ceresoli34, Luca Cattani1, Francesco Minardi1, Edward Tan35, Imtiaz Wani36, Massimo Petranca1, Francesco Domenichelli1, Yunfeng Cui37, Laura Malchiodi1, Emanuele Sani1, Andrey Litvin38, Andreas Hecker39, Vito Montanaro1, Solomon Gurmu Beka40, Salomone Di Saverio41, Sandra Rossi1, Fausto Catena42
1Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
2Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Reggio Emilia, Italy
3Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center, Moreno Valley, USA
4Department of Surgery, Loma Linda University School of Medicine, Loma Linda, USA
5Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
6Department of General Surgery, Oxford University Hospitals NHS Foundation Trust, Headington, Oxford, UK
7Department of Traumatology, John Hunter Hospital, Newcastle, Australia
8Discipline of Surgery, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
9Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, USA
10Department of Surgery, Pisa University Hospital, Pisa, Italy
11Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
12Department of Surgery, University of Washington, Seattle, USA
13Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt Am Main, Frankfurt am Main, Germany
14Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genova, Italy
15Dipartimento Di Scienze Chirurgiche Diagnostiche Integrate, University of Genova, Genova, Italy
16Department of General Surgery, Macerata Hospital, Macerata, Italy
17Humanitas University, Milan, Italy
18Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
19College of Osteopathic Medicine, Rocky Vista University, Parker, USA
20The Medical Center of Aurora, Aurora, USA
21Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
22Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
23ECMO Team, Bufalini Hospital, Cesena, Italy
24Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, USA
25Department of General Surgery, University Hospital of Pavia, Pavia, Italy
26General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Canada
27Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
28Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
29General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
30Department of General and Metabolic Surgery, Poissy and Saint-Germain-en-Laye Hospitals, Poissy, France
31Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
32Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
33Surgery Department, Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Campinas, Brazil
34General Surgery Department, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
35Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
36Department of Minimal Access and General Surgery, Government Gousia Hospital, Srinagar, India
37Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
38Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
39Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
40Ethiopian Air Force Hospital, Bishoftu, Ethiopia
41Department of General Surgery, Ospedale Civile “Madonna del Soccorso”, San Benedetto del Tronto, Italy
42Department of General and Emergency Surgery, “M. Bufalini” Hospital, Cesena, Italy

Tóm tắt

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. 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. 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. 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.

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