“Hemodynamic management is one of the only available treatment options that likely improves neurologic outcomes in patients with acute traumatic spinal cord injury (SCI). Augmenting mean arterial pressure (MAP) aims to improve blood perfusion and oxygen delivery to the injured spinal cord in order to minimize secondary ischemic damage to neural tissue. The objective of this guideline was to update the 2013 AANS/CNS recommendations on the hemodynamic management of patients with acute traumatic SCI, acknowledging that much has been published in this area since its publication. Specifically, we sought to make recommendations on
1. The range of mean arterial pressure (MAP) to be maintained by identifying an upper and lower MAP limit;
2. The duration of such MAP augmentation; and
3. The choice of vasopressor. Additionally, we sought to make a recommendation on spinal cord perfusion pressure (SCPP) targets.”

Kwon, Brian K et al. “A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on Hemodynamic Management.” Global spine journal vol. 14,3_suppl (2024): 187S-211S.

“For recommendation #1, 89% of the GDG voted to accept and endorse this 2013 statement regarding the use of cardiac, hemodynamic and respiratory monitoring devices. The GDG
agreed that patients with SCI often require a higher level of care and close monitoring in an ICU setting given increased rates of respiratory insufficiency, cardiac dysfunction and
systemic hypotension. Patients with cervical SCI may require mechanical ventilation. Early detection of cardiopulmonary dysfunction and hemodynamic instability may allow for
timely implementation of effective and life-saving strategies. The GDG acknowledged that some patients with less severe SCI, such as those with a mild “central cord syndrome” pattern of incomplete tetraplegia, may be safely monitored and managed in a step down or acute care unit. Furthermore, it was recognized that providing ICU level care for every SCI patient might not be feasible in resource-limited clinical settings (eg low or middle-income countries).
For recommendation #2, 84% of the GDG voted to accept and endorse this 2013 statement regarding the correction of hypotension to a systolic blood pressure above 90 mmHg. As
stated previously, the injured spinal cord is particularly susceptible to decreases in systolic blood pressure given impaired vascular reactivity and loss of auto-regulation. Given that
small changes in the perfusion of the spinal cord can worsen ischemia and propagate secondary injury, the GDG agreed that systemic hypotension should be avoided or corrected as soon as possible. Furthermore, the GDG recognized that maintaining a systolic blood pressure over 90 mmHg represents standard of care for most patients admitted to the hospital to ensure adequate systemic perfusion and limit end-organ damage.
For recommendation #3 on the MAP target of 85-90 mmHg for 7 days, 84% of the GDG voted to revise this recommendation based on the reasons outlined in the introduction.
The GDG then aimed to establish a new recommendation by addressing 3 key components of hemodynamic management: (i) the upper and lower limits of a MAP target range; (ii) the
optimal duration of MAP augmentation; and (iii) the choice of vasopressor or inotrope for pharmacologic support of MAP.”

Kwon, Brian K et al. “A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on Hemodynamic Management.” Global spine journal vol. 14,3_suppl (2024)