A systematic review of the evidence supporting a role for vasopressor support in acute SCI

A systematic review of clinical and preclinical literature.

To critically evaluate the evidence supporting a role for vasopressor support in the management of acute spinal cord injury and to provide updated recommendations regarding the appropriate clinical application of this therapeutic modality.

Only few clinical studies exist examining the role of arterial pressure and vasopressors in the context of spinal cord trauma.

Medical literature was searched from the earlier available date to July 2009 and 32 articles (animal and human literature) answering the following four questions were studied: what patient groups benefit from vasopressor support, which is the optimal hypertensive drug regimen, which is the optimal duration of the treatment and which is the optimal arterial blood pressure. Outcome measures used were the incidence of patients needing vasopressors, the increase of arterial blood pressure and neurologic improvement.

Patients with complete cervical cord injuries required vasopressors more frequently than either incomplete injuries or thoracic/lumbar cord injuries (P<0.001). There was no statistical difference in neurologic improvement between patients on vasopressor support with a mean arterial pressure (MAP) of less than 85 mm Hg and those with MAP less than 90 mm Hg. Duration of treatment is often recommended between 5 and 7 days although this is not supported by high-level evidence and no single vasopressor appeared superior over the variety used in clinical treatment.

There is currently no gold standard on vasopressor support. Based on non-randomized human studies, complete cervical cord injuries require vasopressors more frequently than other spinal cord injuries.