Thank you for this opportunity. My name is James Malcolm. I'm from Emory in Atlanta, Georgia. I will present on vasopressor use and spinal cord injury for MAP goals and the consequences of this with frail patients. Spinal cord injury affects over 17,000 patients a year. And as varied as the injury patterns are, so are the outcomes. One of the few tools we have to help patients is blood pressure augmentation to reduce secondary injury. In 2013, the AANS released guidelines recommending MAP goals. However, much of this data at the time was based on small observational studies. In 2017, a review found that there's still very little high-quality data available. Further, vasopressor use to achieve MAP goals is not without complications, which has received little attention within the spinal trauma research. And we know that frail patients are particularly vulnerable to long-term use. The goal of the study is to evaluate complications associated with vasopressor use and spinal cord injury. We hypothesize that frail patients receiving vasopressors from MAP goals will have greater rates of morbidity and mortality. There were 186 patients in this cohort. Seventy had no frailty, 56 with mild, two with moderate, and 20 classified as severe. Median duration of MAP goals was five days with an interquartile range of five to five, which reflects our standard protocol. Asia A patients were less frail. Vasopressors were applied regardless of frailty level. Stratifying patients by not severe versus severe frailty, we looked at complications. There were no differences for acute respiratory distress syndrome, bradycardia, tachycardia, cardiac arrest, or sepsis. However, mortality, troponin leak, and unplanned intubation all had differences. As expected, the severely frail population had a higher mortality, more troponemia, and more unplanned intubations. By unplanned intubation, we mean intubation in the ICU after the initial stabilization in the emergency department. Focusing on this small severe subgroup, we repeat the analysis using a blocking technique. Specifically, we use the Cochrane-Mantle-Heinzel method to test if there is a relationship between vasopressor use while controlling for severity of frailty. We find that among severe patients, those that received vasopressors had higher mortality and more unplanned intubations. Both of these associations are strengthened after controlling for severity. Oddly, we now find that troponemia is slightly higher in the no vasopressor group. However, given that there were no difference in cardiac arrest, we might conclude that this is mainly clinically insignificant if the troponin leak did not lead to cardiac arrest. In conclusion, while frail patients have higher mortality as expected, it appears that vasopressor use is more dangerous in this group. We must take care when prescribing MAP goals, taking into consideration potential benefit in neurologic outcome versus more immediate risk of complications. There are several important limitations to keep in mind. First, this is a retrospective study with the typical caveats and biases. This is a very small study with unbalanced cohorts. We ultimately focused on a very small subgroup with a severe frailty to CFX, and finally found MAP goals to be applied inconsistently across Asia grades. Thank you.

vasopressors

spinal cord injury

frail patients

blood pressure augmentation

complications