Interventions for Cardiovascular Complications during Acute SCI

The treatment of neurogenic shock requires correction of bradycardia and arterial hypotension, beginning with proper fluid resuscitation. Clinical data on treatment of neurogenic shock is limited despite it being a common complication.

Current pharmacological management of bradycardia in SCI patients involves the use of different agents including phosphodiesterase inhibitors (e.g., aminophylline, theophylline) and chronotropic agents (e.g., atropine, epinephrine, and norepinephrine). Cardiac pacemaker implantation as therapy for bradycardia is only reserved for those patients with refractory bradycardia who do not respond to pharmacologic treatment (Evans et al. 2014; Franga et al. 2006; Ruiz-Arango et al. 2006; Sadaka et al. 2010; Wood et al. 2014).

The management of arterial hypotension involves the use of vasopressors to maintain a mean arterial pressure (MAP) of 85-90 mmHg including dopamine, norepinephrine, and dobutamine (Ploumis et al. 2010; Wood et al. 2014). OH can be managed through both non-pharmacological and pharmacological methods, although the first line of therapy emphasizes non-pharmacological treatment. Adequate fluid and salt intake is advised to maintain plasma volume, and consumption of diuretics such as alcohol and caffeine is discouraged. SCI patients need also be cognizant of the symptoms associated with OH and should assume a recumbent position if they occur (Claydon et al. 2006; Popa et al. 2010). Non-pharmacological management may also include the use of electrical stimulation of limbs, as well as compression/pressure devices (Gillis et al. 2008). Pharmacological management of OH consists of using fludrocortisone to expand plasma volume. Alternatively, midodrine hydrochloride, a sympathomimetic alpha1-agonist, is used to improve OH by increasing BP through arteriole and vein constriction and thus increasing total peripheral resistance (Claydon et al. 2006; Phillips et al. 2014).