Cardio-centric hemodynamic management improves spinal cord oxygenation and mitigates hemorrhage in acute spinal cord injury

Alexandra M. Williams, Neda Manouchehri, Erin Erskine, Keerit Tauh, Kitty So, Katelyn Shortt, Megan Webster, Shera Fisk, Avril Billingsley, Alex Munro, Seth Tigchelaar, Femke Streijger, Kyoung-Tae Kim, Brian K. Kwon and Christopher R. West ()
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Alexandra M. Williams: University of British Columbia
Neda Manouchehri: University of British Columbia
Erin Erskine: University of British Columbia
Keerit Tauh: University of British Columbia
Kitty So: University of British Columbia
Katelyn Shortt: University of British Columbia
Megan Webster: University of British Columbia
Shera Fisk: University of British Columbia
Avril Billingsley: University of British Columbia
Alex Munro: University of British Columbia
Seth Tigchelaar: University of British Columbia
Femke Streijger: University of British Columbia
Kyoung-Tae Kim: University of British Columbia
Brian K. Kwon: University of British Columbia
Christopher R. West: University of British Columbia

Nature Communications, 2020, vol. 11, issue 1, 1-12

Abstract: Abstract Chronic high-thoracic and cervical spinal cord injury (SCI) results in a complex phenotype of cardiovascular consequences, including impaired left ventricular (LV) contractility. Here, we aim to determine whether such dysfunction manifests immediately post-injury, and if so, whether correcting impaired contractility can improve spinal cord oxygenation (SCO2), blood flow (SCBF) and metabolism. Using a porcine model of T2 SCI, we assess LV end-systolic elastance (contractility) via invasive pressure-volume catheterization, monitor intraparenchymal SCO2 and SCBF with fiberoptic oxygen sensors and laser-Doppler flowmetry, respectively, and quantify spinal cord metabolites with microdialysis. We demonstrate that high-thoracic SCI acutely impairs cardiac contractility and substantially reduces SCO2 and SCBF within the first hours post-injury. Utilizing the same model, we next show that augmenting LV contractility with the β-agonist dobutamine increases SCO2 and SCBF more effectively than vasopressor therapy, whilst also mitigating increased anaerobic metabolism and hemorrhage in the injured cord. Finally, in pigs with T2 SCI survived for 12 weeks post-injury, we confirm that acute hemodynamic management with dobutamine appears to preserve cardiac function and improve hemodynamic outcomes in the chronic setting. Our data support that cardio-centric hemodynamic management represents an advantageous alternative to the current clinical standard of vasopressor therapy for acute traumatic SCI.

Date: 2020
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DOI: 10.1038/s41467-020-18905-8

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