TY - JOUR
T1 - The acute phase management of spinal cord injury affecting polytrauma patients
T2 - the ASAP study
AU - Picetti, Edoardo
AU - Iaccarino, Corrado
AU - Coimbra, Raul
AU - Abu-Zidan, Fikri
AU - Tebala, Giovanni D.
AU - Balogh, Zsolt J.
AU - Biffl, Walter L.
AU - Coccolini, Federico
AU - Gupta, Deepak
AU - Maier, Ronald V.
AU - Marzi, Ingo
AU - Robba, Chiara
AU - Sartelli, Massimo
AU - Servadei, Franco
AU - Stahel, Philip F.
AU - Taccone, Fabio S.
AU - Unterberg, Andreas W.
AU - Antonini, Marta Velia
AU - Galante, Joseph M.
AU - Ansaloni, Luca
AU - Kirkpatrick, Andrew W.
AU - Rizoli, Sandro
AU - Leppaniemi, Ari
AU - Chiara, Osvaldo
AU - De Simone, Belinda
AU - Chirica, Mircea
AU - Shelat, Vishal G.
AU - Fraga, Gustavo P.
AU - Ceresoli, Marco
AU - Cattani, Luca
AU - Minardi, Francesco
AU - Tan, Edward
AU - Wani, Imtiaz
AU - Petranca, Massimo
AU - Domenichelli, Francesco
AU - Cui, Yunfeng
AU - Malchiodi, Laura
AU - Sani, Emanuele
AU - Litvin, Andrey
AU - Hecker, Andreas
AU - Montanaro, Vito
AU - Beka, Solomon Gurmu
AU - Di Saverio, Salomone
AU - Rossi, Sandra
AU - Catena, Fausto
N1 - Funding Information:
We would like to thank WSES and EANS for the support. LIST of CONTRIBUTORS* Italy : Francesco Domenichelli, Gennaro Perrone, Carlo Giussani, Graziano Taddei, Osvaldo Chiara, Marco Meloni, Carlo Coniglio, Stefano Romoli, Nino Stocchetti, Giuseppe Citerio, Teresa Perra, Claudio Bernucci, Luca Longhi, Alberto Balestrino, Massimiliano Visocchi, Pasquale De Bonis, Francesco Costa, Laura Lippa, Giovanni Pinna, Maurizio Passanisi, Massimiliano Maria Pina, Simona Bistazzoni, Maximilian Broger, Maurizio Magliulo, Mario Giuffrida, Roberto Colasanti, Cristian Lupi, Vitaliano F. Muzii. Brazil : Jos? Mauro da Silva Rodrigues, Bruno M. Pereira, Gustavo P. Fraga, Ricardo, Alessandro Teixeira Gonsaga. United Kingdom : Charalampos Seretis, Mario Ganau, Edoardo Viaroli, Andreas Demetriades. Paraguay : Gustavo M. Machain. Greece : Eftychios Lostoridis, Orestis Ionnadis. Turkey : Arda Isik. South Africa : Timothy Hardcastle, Victor Kong. United Arab Emirates : Fikri Abu-Zidan. The Netherlands : Edward Tan, Vincent J.M. Leferink, Wilco Peul. Chile : Cristian Godoy. Israel : Miklosh Bala, Boris Kessel. Canada : Gregory Hawrylux, Andrew Kirkpatrick. Spain : Jesus Sanchez Ballesteros, Adriana Gil-Rodrigo, Juan A. Sinisterra, Fernando Clau. Tunisia : Oussama Baraket. USA : Rocco Armonda, Addisu Mesfin, Matthew Martin, Sabareesh Natarajan, Jeremy Cannon, Eelco F. Wijdicks, Manny Lorenzo, Marc de Moya, David Livingston, Therese Duane, Joe DuBose, Stuart Hershman, Joseph Schwab, Tom Scalea, Gary Schwartzbauer, Jose Diaz, Rosemary Kozar, Sharon Henry, Harold Fogel, Christos Lazaridis, Randall M. Chesnut, Alejandro Rabinstein, Jonathan Morrison, P. David Adelson, James Guest. France : Pierre Bouzat, Salvatore Chibbaro. Colombia : Andres M. Rubiano, Luis Ricaurte Arcos, Alvaro Ricardo Soto-Angel, Milton Barbosa, Oscar Gutirerrez Rincon, Sebastian Toro Lopez. Iran : Amin Jahanbakhshi. India : Swatantra Mishra, Subash Vohra, Dhaval Shukla, Yawar Shoaib Ali. Russia : Mahir Gachabayov, Andrey Litvin. Japan : Takahiro Kinoshita, So Kato. Australia : Dieter Weber, Simone Meakes, Ed Martinez, Simon Abson. Singapore : Vishal G Shelat. Sweden : Niklas Marklund, Tal Horer. Romania : Ioan-Alexandru Floriana, Ionut Negoi, Maria Mihaela Pop, Gheorghe Ungureanu. Argentina : Daniel Oscar Pintos Chiesa, Ricardo Carmona, Martin Truszkowski, Fernando Palizas. Per? : Pool Avila, Juan Luis Pinedo. Belarus : Sergey Kirynela. Iraq : Mazin S. Mohammed Jawad. Qatar : Vishw Verma, Mohammad Alabdallat, Mohammed Farhat, Ibrahim Afifi, Yasir Al-Zubaidi, Ahad Kanbar, Suhail Yaqoob, Basil Younis, Hisham Aljogol, Sherwan Rashid M. Khoschnau, Suresh Kumar, Mushreq Ayesh, Talat Chughtai. Hungary : Andras Buki. Pakistan : Amer Aziz Ghurki. Switzerland : Giulia Cossu. Nepal : Bipin Chaurasia. Indonesia : Yunus Kuntawi Aji. Honduras : Ronny Leiva. Vietnam : Duong Lx. Moldova : Cauia Artur. * only those who agree are reported as contributors.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - Management
KW - Polytrauma
KW - Traumatic spinal cord injury
UR - http://www.scopus.com/inward/record.url?scp=85128873142&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85128873142&partnerID=8YFLogxK
U2 - 10.1186/s13017-022-00422-2
DO - 10.1186/s13017-022-00422-2
M3 - Article
C2 - 35468806
AN - SCOPUS:85128873142
SN - 1749-7922
VL - 17
JO - World Journal of Emergency Surgery
JF - World Journal of Emergency Surgery
IS - 1
M1 - 20
ER -