Neurological Prognosis of Acute Cervical Spinal Cord Injury Patients Requiring Catecholamine Administration

Study Design: Retrospective cohort study using aggregated data from our institute. Objective: To examine the effects of hypotension requiring catecholamine (dopamine and epinephrine) administration on neurologic recovery in acute cervical spinal cord injury (SCI). Summary of Background Data: Following spinal cord injury, traumatic blood loss and spinal shock can occur causing low blood pressure resulting in secondary damage to the spinal cord. Surgical intervention and strict blood pressure control have been reported to assist neurological recovery in acute spinal cord injury. However, no reports have examined the neurological prognosis of patients requiring hemodynamic control with a catecholamine. Methods: American Spinal Injury Association (AISIA) Impairment Scale (AIS) grades at the initial examination on admission and at one-month follow-up were compared between the catecholamine administration group (group C) and the no-catecholamine administration group (group N). Results: A total of 229 acute cervical SCI patients were treated and175 patients (130 males, 45 females; mean age 59.1 years) were finally included in this study. Mean blood pressure was maintained at >85 mmHg, and heart rate was maintained at >45/min for 7 days after injury. The percentage of initial AIS grade A was higher in group C (n=28) than in group N (n=147). No patient in group C was AIS grade D. AIS grade improved in 21.4% of group C and 54.4% of group N. The percentage of neurologically improved patients was significantly higher in group N than in group C (p=0.013). In AIS grade C patients, neurological improvement was greater in group N than in group C (p=0.007). Conclusions: This study showed that neurological improvement is poor in acute cervical SCI patients requiring catecholamine administration. Further studies examining the neurological prognosis and ideal hemodynamics are needed.