Clinical Implementation of Novel Spinal Cord Perfusion Pressure Protocol in Acute Traumatic Spinal Cord Injury at U.S. Level I Trauma Center: TRACK-SCI Study

Yue, John K.; Hemmerle, Debra D.; Winkler, Ethan A.; Thomas, Libby; Fernandez, Xuan Duong; Kyritsis, Nikos; Pan, Jonathan Z.; Pascual, Lisa U.; Singh, Vineeta; Weinstein, Philip; Talbott, Jason F.; Huie, J. Russell; Ferguson, Adam R.; Whetstone, William D.; Manley, Geoffrey T.; Beattie, Michael S.; Bresnahan, Jacqueline C.; Mummaneni, Praveen V.; Dhall, Sanjay S.

doi:10.1016/j.wneu.2019.09.044

Cited by 37 publications

(33 citation statements)

References 22 publications

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“…They found that reducing surgical bleeding and performing duroplasty can reduce ISP, but no factor predicted with SCPP. Association Impairment Scale A-C in 15 SCI patients received a lumbar subarachnoid drain (LSAD) by Yue et al to monitor SCPP for five days and SCPP of ≥65 mm Hg in all patients with no complications [ 30 ]. Werndle et al recommended to develop a method to measure the intrathecal pressure at injury site, to perform durotomy with duroplasty, and repeat MRI to evaluate the effect of treatment and recommended to focus more on the cord perfusion, preventing secondary injury [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Medical Communication Services after Traumatic Spinal Cord Injury

Alshorman

Wang

Zhu

et al. 2021

Journal of Healthcare Engineering

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It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).

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Section: Resultsmentioning

confidence: 99%

Medical Communication Services after Traumatic Spinal Cord Injury

Alshorman

Wang

Zhu

et al. 2021

Journal of Healthcare Engineering

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“…Despite these observations, in modern practice patients of acute traumatic SCI are not universally treated with BP augmentation postinjury. [55][56][57][58] Levi et al 59 investigated 50 acute SCI patients with aggressive management protocol with invasive hemodynamic monitoring, volume, and pressor support to maintain a mean BP of more than 90 mmHg. At admission, 8 patients had severe hypotension (systolic BP [SBP] < 90 mmHg).…”

Section: Cardiopulmonary Management and Its Effect On Prognosismentioning

confidence: 99%

Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations

et al. 2020

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“…Recent retrospective clinical studies of high-resolution physiological monitoring further supports MAP should be maintained above 85–90 mmHg up to seven days upon the patient’s admission to a hospital, and the proportion of time below 85 mmHg correlated with impaired recovery ( Hawryluk et al, 2015 ; Sabit et al, 2018 ; Walters et al, 2013 ). Physiologically, the rational is that spinal cord perfusion pressure depends on systemic MAP remaining high enough to sustain tissue oxygenation in the injury penumbra in the face of vertebral fracture and cord compression ( Squair et al, 2019 ; Yue et al, 2020 ). This SCI clinical guideline mirrors the logic of intracranial pressure monitoring in traumatic brain injury and other fields of cranial neurosurgery where prevention of hypotension using fluids and vasopressors is used to maintain intracranial pressure and decompressive hemicraniectomy is used to prevent pressure overshoot ( Chesnut et al, 2020 ; Shah et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Excavating FAIR Data: the Case of the Multicenter Animal Spinal Cord Injury Study (MASCIS), Blood Pressure, and Neuro-Recovery

et al. 2021

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Meta-analyses suggest that the published literature represents only a small minority of the total data collected in biomedical research, with most becoming ‘dark data’ unreported in the literature. Dark data is due to publication bias toward novel results that confirm investigator hypotheses and omission of data that do not. Publication bias contributes to scientific irreproducibility and failures in bench-to-bedside translation. Sharing dark data by making it Findable, Accessible, Interoperable, and Reusable (FAIR) may reduce the burden of irreproducible science by increasing transparency and support data-driven discoveries beyond the lifecycle of the original study. We illustrate feasibility of dark data sharing by recovering original raw data from the Multicenter Animal Spinal Cord Injury Study (MASCIS), an NIH-funded multi-site preclinical drug trial conducted in the 1990s that tested efficacy of several therapies after a spinal cord injury (SCI). The original drug treatments did not produce clear positive results and MASCIS data were stored in boxes for more than two decades. The goal of the present study was to independently confirm published machine learning findings that perioperative blood pressure is a major predictor of SCI neuromotor outcome (Nielson et al., 2015). We recovered, digitized, and curated the data from 1125 rats from MASCIS. Analyses indicated that high perioperative blood pressure at the time of SCI is associated with poorer health and worse neuromotor outcomes in more severe SCI, whereas low perioperative blood pressure is associated with poorer health and worse neuromotor outcome in moderate SCI. These findings confirm and expand prior results that a narrow window of blood-pressure control optimizes outcome, and demonstrate the value of recovering dark data for assessing reproducibility of findings with implications for precision therapeutic approaches.

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Clinical Implementation of Novel Spinal Cord Perfusion Pressure Protocol in Acute Traumatic Spinal Cord Injury at U.S. Level I Trauma Center: TRACK-SCI Study

Cited by 37 publications

References 22 publications

Medical Communication Services after Traumatic Spinal Cord Injury

Medical Communication Services after Traumatic Spinal Cord Injury

Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations

Excavating FAIR Data: the Case of the Multicenter Animal Spinal Cord Injury Study (MASCIS), Blood Pressure, and Neuro-Recovery

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