Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial
Background Treatment of blunt traumatic spinal cord injuries (SCIs) often includes maintaining elevated mean arterial blood pressures (MAP) to enhance perfusion to the spinal cord. Optimal hyperperfusion protocols and treatment algorithms have yet to be delineated due to a paucity of large volume pr...
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BMJ Publishing Group
2025-08-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/3/e001768.full |
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| author | Jeffry Nahmias Ryan Peter Dumas Brian Daley Dalier R Mederos Bradley M Dennis Michael Steven Farrell Stephanie Scott Gregory Schaefer Asanthi Ratnasekera Alison Smith Scott Armen Joshua Hill Carlos H Palacio Caitlin Anne Fitzgerald Stephanie Doris Claudia Alvarez John D Berne Lindsey Perea Aimee LaRiccia James Bardes Bhairav Shah Tanisha Kashikar Erik Teicher Jennifer Huber Malia Eischen H Akin Erol Lauren Colom Melissa Moncrief William DeVoe William Brigode Melissa Linskey Dougherty Emily Alberto Stephen Gadomski Salina Wydo Jennifer Schweinsburg M Chance Spalding |
| author_facet | Jeffry Nahmias Ryan Peter Dumas Brian Daley Dalier R Mederos Bradley M Dennis Michael Steven Farrell Stephanie Scott Gregory Schaefer Asanthi Ratnasekera Alison Smith Scott Armen Joshua Hill Carlos H Palacio Caitlin Anne Fitzgerald Stephanie Doris Claudia Alvarez John D Berne Lindsey Perea Aimee LaRiccia James Bardes Bhairav Shah Tanisha Kashikar Erik Teicher Jennifer Huber Malia Eischen H Akin Erol Lauren Colom Melissa Moncrief William DeVoe William Brigode Melissa Linskey Dougherty Emily Alberto Stephen Gadomski Salina Wydo Jennifer Schweinsburg M Chance Spalding |
| author_sort | Jeffry Nahmias |
| collection | DOAJ |
| description | Background Treatment of blunt traumatic spinal cord injuries (SCIs) often includes maintaining elevated mean arterial blood pressures (MAP) to enhance perfusion to the spinal cord. Optimal hyperperfusion protocols and treatment algorithms have yet to be delineated due to a paucity of large volume prospective studies. This study aims to identify predictors of neurological improvement in American Spinal Injury Association (ASIA) impairment score following blunt SCI.Study design Prospective (January 10, 2021 to June 1, 2023) multicenter study included blunt SCI patients age >18 with complete neurological examination documented on hospital arrival. Patients were divided into two groups: neurological improvement and no improvement, based on their change in ASIA score from arrival to hospital discharge.Results A total of 19 centers contributed 222 patients of those, 164 had pre-ASIA and post-ASIA scores. The ASIA improvement group had 36 patients (22%). There was no statistical difference in the median percentage of time patients spent at a MAP >85 mm Hg during treatment 80.7% (IQR 63.6, 93.4) no improvement vs 83.6% (IQR 70.1, 93.0) in the improvement, (p=0.87). There was no difference in the median duration of MAP treatment in hours between the groups (95.6 hours (IQR 62.55, 113.48) in the no improvement group versus 96 (IQR 72, 113.5) (p=0.40) in the improvement group).Conclusions Overall, 22% of all blunt SCI patients saw an improvement in their ASIA score. Adherence to and length of MAP augmentation was not a statistically significantly different between groups.Level of evidence Level IV Therapeutic/Care Management. |
| format | Article |
| id | doaj-art-48ea6745d867495db621576bd634ff0b |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-48ea6745d867495db621576bd634ff0b2025-08-20T03:42:18ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-08-0110310.1136/tsaco-2025-001768Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trialJeffry Nahmias0Ryan Peter Dumas1Brian Daley2Dalier R Mederos3Bradley M Dennis4Michael Steven Farrell5Stephanie Scott6Gregory Schaefer7Asanthi Ratnasekera8Alison Smith9Scott Armen10Joshua Hill11Carlos H Palacio12Caitlin Anne Fitzgerald13Stephanie Doris14Claudia Alvarez15John D Berne16Lindsey Perea17Aimee LaRiccia18James Bardes19Bhairav Shah20Tanisha Kashikar21Erik Teicher22Jennifer Huber23Malia Eischen24H Akin Erol25Lauren Colom26Melissa Moncrief27William DeVoe28William Brigode29Melissa Linskey Dougherty30Emily Alberto31Stephen Gadomski32Salina Wydo33Jennifer Schweinsburg34M Chance Spalding35Texas Health Presbyterian Hospital, Dallas, Texas, USASurgery, UT Southwestern Medical, Dallas, Texas, USASurgical Critical Care, University of Tennessee Medical Center, Knoxville, Tennessee, USA5 Division of Trauma and Critical Care, Broward Health, Fort Lauderdale, Florida, USA2 Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USASurgery, Lehigh Valley Health Network, Allentown, Pennsylvania, USA6Obstetrics and Gynecology, University of Dalhousie, Halifax, NS, CanadaDivision of Trauma, Acute Care Surgery and Critical Care, Department of Surgery, West Virginia University, Morgantown, West Virginia, USAChristianaCare Health System, Newark, DE, USA5 Hertfordshire and West Essex Integrated Care Board, Hertfordshire, UKUnited States Army Reserve, Fort Liberty, North Carolina, USAgeneral practitionerSouth Texas Health System, Edinburg, Texas, USAEast Carolina University, Greenville, North Carolina, USADepartment of Surgery, OhioHealth, Columbus, Ohio, USAUC Irvine Healthcare, Orange, California, USABroward Health Medical Center, Fort Lauderdale, Florida, USALancaster General Health, Lancaster, Pennsylvania, USAEast Carolina University, Greenville, North Carolina, USASurgery, West Virginia University, Morgantown, West Virginia, USAOhioHealth, Columbus, Ohio, USAOhioHealth, Columbus, Ohio, USASurgery, Inova Fairfax Medical Center, Falls Church, Virginia, USALancaster General Health, Lancaster, Pennsylvania, USAQueen’s Medical Center, Honolulu, Hawaii, USAQueen’s Medical Center, Honolulu, Hawaii, USALehigh Valley Health Network, Allentown, Pennsylvania, USATrauma, Kettering Health Main Campus, Kettering, Ohio, USARiverside Methodist Hospital, Columbus, Ohio, USACook County Health, Chicago, Illinois, USASurgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USATrauma, ChristianaCare, Wilmington, Delaware, USAVanderbilt University Medical Center, Nashville, Tennessee, USACooper University Hospital Regional Trauma Center, Camden, New Jersey, USACooper University Hospital Regional Trauma Center, Camden, New Jersey, USATrauma and Surgical Critical Care, Mount Carmel Hospital, Columbus, Ohio, USABackground Treatment of blunt traumatic spinal cord injuries (SCIs) often includes maintaining elevated mean arterial blood pressures (MAP) to enhance perfusion to the spinal cord. Optimal hyperperfusion protocols and treatment algorithms have yet to be delineated due to a paucity of large volume prospective studies. This study aims to identify predictors of neurological improvement in American Spinal Injury Association (ASIA) impairment score following blunt SCI.Study design Prospective (January 10, 2021 to June 1, 2023) multicenter study included blunt SCI patients age >18 with complete neurological examination documented on hospital arrival. Patients were divided into two groups: neurological improvement and no improvement, based on their change in ASIA score from arrival to hospital discharge.Results A total of 19 centers contributed 222 patients of those, 164 had pre-ASIA and post-ASIA scores. The ASIA improvement group had 36 patients (22%). There was no statistical difference in the median percentage of time patients spent at a MAP >85 mm Hg during treatment 80.7% (IQR 63.6, 93.4) no improvement vs 83.6% (IQR 70.1, 93.0) in the improvement, (p=0.87). There was no difference in the median duration of MAP treatment in hours between the groups (95.6 hours (IQR 62.55, 113.48) in the no improvement group versus 96 (IQR 72, 113.5) (p=0.40) in the improvement group).Conclusions Overall, 22% of all blunt SCI patients saw an improvement in their ASIA score. Adherence to and length of MAP augmentation was not a statistically significantly different between groups.Level of evidence Level IV Therapeutic/Care Management.https://tsaco.bmj.com/content/10/3/e001768.full |
| spellingShingle | Jeffry Nahmias Ryan Peter Dumas Brian Daley Dalier R Mederos Bradley M Dennis Michael Steven Farrell Stephanie Scott Gregory Schaefer Asanthi Ratnasekera Alison Smith Scott Armen Joshua Hill Carlos H Palacio Caitlin Anne Fitzgerald Stephanie Doris Claudia Alvarez John D Berne Lindsey Perea Aimee LaRiccia James Bardes Bhairav Shah Tanisha Kashikar Erik Teicher Jennifer Huber Malia Eischen H Akin Erol Lauren Colom Melissa Moncrief William DeVoe William Brigode Melissa Linskey Dougherty Emily Alberto Stephen Gadomski Salina Wydo Jennifer Schweinsburg M Chance Spalding Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial Trauma Surgery & Acute Care Open |
| title | Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial |
| title_full | Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial |
| title_fullStr | Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial |
| title_full_unstemmed | Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial |
| title_short | Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial |
| title_sort | does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries an east multicenter trial |
| url | https://tsaco.bmj.com/content/10/3/e001768.full |
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