Hypothermia Following Acute Spinal Cord Injury

Efficacy of Intravenously Instituted Hypothermia Treatment in Improving Functional Outcomes in Patients Following Acute Spinal Cord Injury

The purpose of this study is to investigate the long term outcome of patients who receive hypothermia treatment for spinal cord injury. At this institution, intravascular hypothermia has been used for certain patients with spinal cord injury for the past two years. This study will collect data from vital signs and examinations while the patient is in the hospital and also when they follow up as an outpatient after they are discharged or go to a rehabilitation center. This data will then be analyzed and compared only to historically published data from previous studies. The aim of this investigation is to determine if intravascular hypothermia results in a beneficial outcome for patients with spinal cord injury.

Study Overview

• Status: Completed
• Conditions: Spinal Cord Injury

Detailed Description

It is standard practice at this institution for patients with complete acute spinal cord injury to receive hypothermia. Incomplete injuries may also be treated with hypothermia. This will be a prospective analysis of the data collected at our institution from patients with acute spinal cord injury receiving the hypothermia protocol. The care of these patients will not be affected by this research. Data for normothermia (37 degrees Celsius) will be obtained from historical studies analyzing similar patient groups. Patients arriving to this emergency department have a baseline neurological examination in a timely fashion prior to the induction of hypothermia by a neurosurgical attending or resident. All patients have Magnetic Resonance Imaging (MRI) of the injured spinal cord on admission. Patients that are intubated and medically sedated prior to the initial exam by the neurosurgical team are excluded because the exam at that time may be inaccurate. Patients receiving hypothermia are transferred to the Neurosurgical ICU, intubated and sedated using muscle relaxants. Additional forms of sedation including benzodiazepines or dexmedetomidine are routinely used as an adjunct to curtail a shivering response. For all patients receiving hypothermia, an Alsius CoolGard® Icy Catheter is placed into the Inferior Vena Cava (IVC) via the femoral vein and the temperature cooled to target (33 degrees) at the maximum rate (0.5 degrees/hr). Mean arterial pressure (MAP) is kept >90 mm Hg at all times with fluid boluses (Normal Saline or Albumin 5%) or blood transfusions to keep the hematocrit at 30. Hypothermia at 33 degrees is maintained for 48 hours. Blood cultures are performed daily (from both a peripheral site and from the catheter itself) and an Orogastric tube (OGT) or Nasogastric tube (NGT) is placed in each patient. Nutrition is provided as per our current nutritional supplementation protocol. Intravenous fluids consist of Normal Saline at all times unless the serum Na rises above 160. Serum electrolytes, coagulation studies and complete blood count are performed daily. After 48 hours of hypothermia, the patient is rewarmed to 37 degrees at a controlled rate of 0.1 degree/hr. After reaching 37 degrees, the intravenous catheter is maintained for no more than 6 days total to keep the systemic temperature at 37 degrees. Surface cooling techniques are occasionally utilized for the purpose of maintaining normothermia after 6 days. The patients are discharged to rehabilitation after they are stabilized. All patients will be reevaluated at 6 weeks, 6, and 12 months using the American Spinal Injury Association (ASIA) sensory and motor scales with Functional Independence Measures (FIM). A follow-up MRI scan will be done at one year.

• Study Type: Observational
• Enrollment (Actual): 41

Contacts and Locations

Study Locations

• United States
  • Florida
    • Miami, Florida, United States, 33136
      • Jackson Memorial Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Acute spinal cord injury patients.

Description

Inclusion Criteria:

• 18 - 65 years of age, ASIA (American Spinal Injury Association) Impairment Scale (AIS) Score A or B, non-penetrating injury, and absence of severe systemic injury or coagulopathy. Patients urgently taken to the OR for reduction may also be included.

Exclusion Criteria:

• Age > 65 years, ASIA (American Spinal Injury Association) Impairment Scale (AIS) Score C or D, Hyperthermia on admission (> 37 degrees Celsius), Severe systemic injury, Severe bleeding, Pregnancy, Coagulopathy, Thrombocytopenia, Known prior cardiac history, Blood dyscrasia, Pancreatitis, Raynuad's syndrome, Penetrating spinal column injury (gunshot and knife wounds etc.), Cord transection. Patients who are intubated and sedated prior to initial examination by the neurosurgical team and patients showing an improvement in the neurologic exam within 12 hours from the injury will also be excluded.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
International Standards of Neurological Classification for Spinal Cord Injury	Change from Baseline at 12 months

Collaborators and Investigators

• Sponsor: University of Miami
• Investigators: Principal Investigator: Allan D Levi, MD, PhD, University of Miami

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2007
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): December 1, 2018

Study Registration Dates

• First Submitted: November 28, 2012
• First Submitted That Met QC Criteria: November 28, 2012
• First Posted (Estimate): November 30, 2012

Study Record Updates

• Last Update Posted (Actual): January 9, 2019
• Last Update Submitted That Met QC Criteria: January 7, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Trauma, Nervous System; Spinal Cord Diseases; Body Temperature Changes; Wounds and Injuries; Spinal Cord Injuries; Hypothermia
• Other Study ID Numbers: 20060556

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO