PREVALENCE OF PRE-HOSPITAL HAEMODYNAMIC INSTABILITY IN THE ACUTE PHASE OF TRAUMATIC SPINAL CORD INJURY (SCI)
1Clark J, 2Rao P, 1Freeman B, 1Atherton M
1ROYAL ADELAIDE HOSPITAL, ADELAIDE, South aust, Australia; 2ROYAL ADELAIDE HOSPIAL, ADELAIDE, South aust, Australia
BACKGROUND: Continuous intraspinal pressure monitoring experiments provide new understanding of the detrimental role of haemodynamic instability in the acute phase of SCI. Of relevance to attempts to optimise neurological recovery, it is important to understand haemodynamic instability and intraspinal pressure in the context of the process of care provided from the accident scene to the surgical hospital.
AIMS: To evaluate pre- and first 3-day surgical hospital haemodynamic parameters and examine correlates of neurological outcome.
METHODS: A medical record audit of all new-incident SCI cases presenting to the Royal Adelaide Hospital (2009 -2016) was conducted. Vital parameters for the first 3-days, and admission/ discharge ASIA Impairment Scale (AIS) grades were tabulated.
RESULTS: 74 patients, 67 male, 57% AIS grade A, 7% B, 9% C, 26% D were admitted, of whom 57 had pre-hospital vital data documented. Pre-hospital mean arterial pressure (MAP) values were: Mean 80.5 ±17.5; Maximum 89.3 ±24; and Minimum 70.0 ±21.8 mmHg.
Twenty nine (29) patients had pre-hospital systolic recordings <90 mmhg while 50% (72% AIS A or B) had at least one episode of MAP <80. Pre-hospital Minimum MAP <78 (P=.042) MAP and MAP Range >15 (P=.027) demonstrated sensitivity to discriminate AIS Grade A-B at rehabilitation discharge.
CONCLUSIONS: Pre-hospital data add to the growing data-set demonstrating that haemodynamic instability clusters with more severe neurological injury. Taken together with Minimum MAP, the wider MAP Range is perhaps mechanistically explained by reperfusion injury during progression from the accident scene to the surgical hospital, which may be deleterious to SCI recovery.
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