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

World Journal of Emergency Surgery

Ari Leppaniemi¹  Philip F. Stahel²  Raul Coimbra³  Chiara Robba⁴  Sandra Rossi⁵  Emanuele Sani⁵  Laura Malchiodi⁵  Edoardo Picetti⁵  Francesco Minardi⁵  Vito Montanaro⁵  Luca Cattani⁵  Francesco Domenichelli⁵  Massimo Petranca⁵  Corrado Iaccarino⁶  Mircea Chirica⁷  Massimo Sartelli⁸  Salomone Di Saverio⁹  Giovanni D. Tebala^1,10  Vishal G. Shelat^1,11  Luca Ansaloni^1,12  Fausto Catena^1,13  Belinda De Simone^1,14  Andreas Hecker^1,15  Fabio S. Taccone^1,16  Imtiaz Wani^1,17  Deepak Gupta^1,18  Andreas W. Unterberg^1,19  Fikri Abu-Zidan^2,20  Federico Coccolini^2,21  Edward Tan^2,22  Yunfeng Cui^2,23  Ronald V. Maier^2,24  Andrey Litvin^2,25  Walter L. Biffl^2,26  Ingo Marzi^2,27  Zsolt J. Balogh^2,28  Joseph M. Galante^2,29  Marta Velia Antonini^3,30  Solomon Gurmu Beka^3,31  Marco Ceresoli^3,32  Osvaldo Chiara^3,33  Andrew W. Kirkpatrick^3,34  Franco Servadei^3,35  Gustavo P. Fraga^3,36  Sandro Rizoli^3,37 

[1] Abdominal Center, Helsinki University Hospital and University of Helsinki;College of Osteopathic Medicine, Rocky Vista University;Comparative Effectiveness and Clinical Outcomes Research Center, Riverside University Health System Medical Center;Department of Anaesthesia and Intensive Care, Policlinico San Martino, IRCCS for Oncology and Neuroscience;Department of Anesthesia and Intensive Care, Parma University Hospital;Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia;Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes;Department of General Surgery, Macerata Hospital;Department of General Surgery, Ospedale Civile “Madonna del Soccorso”;Department of General Surgery, Oxford University Hospitals NHS Foundation Trust;Department of General Surgery, Tan Tock Seng Hospital;Department of General Surgery, University Hospital of Pavia;Department of General and Emergency Surgery, “M. Bufalini” Hospital;Department of General and Metabolic Surgery, Poissy and Saint-Germain-en-Laye Hospitals;Department of General and Thoracic Surgery, University Hospital Giessen;Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB);Department of Minimal Access and General Surgery, Government Gousia Hospital;Department of Neurosurgery, All India Institute of Medical Sciences;Department of Neurosurgery, University of Heidelberg;Department of Surgery, College of Medicine and Health Sciences, UAE University;Department of Surgery, Pisa University Hospital;Department of Surgery, Radboud University Medical Centre;Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University;Department of Surgery, University of Washington;Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital;Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital;Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt Am Main;Department of Traumatology, John Hunter Hospital;Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis;ECMO Team, Bufalini Hospital;Ethiopian Air Force Hospital;General Surgery Department, School of Medicine and Surgery, Milano-Bicocca University;General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano;General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre;Humanitas University;Surgery Department, Faculdade de Ciências Médicas (FCM), Unicamp Campinas;Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH);

关键词: Polytrauma;    Traumatic spinal cord injury;    Management;   

DOI  :  10.1186/s13017-022-00422-2

来源: DOAJ

【 摘 要 】

Abstract 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.

【 授权许可】

Unknown