(971) Safety and Efficacy of Vasoactive Therapy for Neurogenic Shock After Acute Spinal Cord Injury

Introduction: Post-spinal cord injury (SCI), cardiovascular dysfunction arises from sympathetic denervation leading to unopposed parasympathetic activity, which manifests as neurogenic shock. As a result, patients may require prolonged hemodynamic support, however no single intravenous (IV) or enteral vasoactive agent is recommended. Thus, clinicians at our institution utilize a variety of agents including atropine, glycopyrrolate, midodrine, pseudoephedrine, and theophylline for controlling these cardiovascular complications.

Methods: All patients diagnosed with SCI admitted to the surgery or neurology ICU who received at least three doses of scheduled atropine, glycopyrrolate, midodrine, pseudoephedrine, or theophylline were included. All agents were analyzed in a descriptive manner. The primary outcome was examining hemodynamic stability in patients post-SCI. This outcome was defined as success or failure with success defined by meeting any one of the following: vasopressor discontinuation, decreased use of as needed anticholinergic agents, or increase in heart rate or mean arterial pressure by at least 20%.

Results: : Among 71 patients with SCI receiving atropine, glycopyrrolate, midodrine, pseudoephedrine, or theophylline, the median duration of therapy was 7.9 days. Forty-five patients (63%) were on IV vasopressors prior to agent initiation. A secondary vasoactive agent for hemodynamic stability was required in 18 patients (25%). The initial vasoactive agent was continued at hospital discharge in 33 patients (46%). When examining the effectiveness of the two most frequently utilized initial vasoactive agents, midodrine and pseudoephedrine, success was observed in 17 patients receiving midodrine and 13 patients receiving pseudoephedrine (47 versus 81%; p < 0.05).

Conclusions: In this population of 71 patients with SCI, varying vasoactive agents were utilized for neurogenic shock. Pseudoephedrine appeared more effective at maintaining hemodynamic stability in patients post-SCI, however larger studies are needed to confirm this finding.