Cervical spinal cord injury and the need for cardiovascular intervention

Hypothesis: The level of cervical spinal cord injury (CSCI) can be used to predict the need for a cardiovascular intervention. Design: Retrospective review. Data included level of spinal cord injury, Injury Severity Score, lowest heart rate, and systolic blood pressure in the first 24 hours and intensive care unit course. The level of CSCI was divided into high (cord level C1-C5) or low (cord level C6-C7). Neurogenic shock was defined as bradycardia with hypotension. Statistical analysis was performed with the t test and the chi(2) test. Setting: Level I trauma center. Patients: The patients studied were those with quadriplegia who experienced a CSCI and were admitted to the hospital between December 1, 1993, and October 31, 2001. Interventions: Pressors, chronotropic agents, and pacemakers. Main Outcome Measure: Use of a cardiovascular intervention in the presence of neurogenic shock. Results: Eighty-three patients met the criteria for CSCI and quadriplegia, 62 in the high (C1-C5) and 21 in the low (C6-C7) level. There was no significant difference between the 2 groups in mean+/-SD age (38.2+/-17.8 vs 34.7+/-15.6 years; P=.43), mean+/-SD Injury Severity Score (35.7+/-17.5 vs 32.5+/-11.2; P=.44), mean+/-SD admission base deficit (-0.7+/-3.6 vs 0.7+/-2.7; P=.06), or mortality (12 [19%] of 62 patients vs 2 [10%] of 21 patients; P=.29). Neurogenic shock was present in 19 (31%) of the 62 patients with high CSCI and in 5 (24%) of the 21 patients with low CSCI (P=.56). There was a marked difference in the use of a cardiovascular intervention between those with a high and those with a low CSCI: 15 (24%) of 62 patients vs 1 (5%) of 21 patients (P=.02). Two patients with C1 through C5 spinal cord injuries required cardiac pacemakers. Conclusions: There was no significant difference in the frequency of neurogenic shock by injury level. Patients with a high CSCI (C1-C5) had a significantly greater requirement for a cardiovascular intervention compared with patients with lower injuries (C6-C7).