Katzer S, Cronin L, Dunlap E, Rosenberger S, Talley D, Toursavadkohi S. Implementation of a treatment algorithm to decrease incidence of paralysis post endovascular thoracoabdominal aorta repair.
JOURNAL OF VASCULAR NURSING 2020;
39:6-10. [PMID:
33894954 DOI:
10.1016/j.jvn.2020.12.001]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/05/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND
Spinal cord ischemia (SCI) is a rare but devastating complication following aortic repair. Despite improvements in operative management and critical care of aortic disease patients, SCI remains one of the most serious and common complications after these procedures. Early recognition and rescue interventions can augment the outcome and reduce the morbidity or avoid permanent dysfunction. This is a single institution experience of creating an evidence-based algorithm for the treatment of SCI in patients after thoracoabdominal endovascular aortic repair (TEVAR).
INTERVENTION/METHODS
We implemented an evidence-based treatment algorithm for the management of acute SCI after TEVAR. A total of 131 TEVAR cases were reviewed, 59 cases preimplementation, and 72 cases postimplementation of an SCI treatment algorithm.
RESULTS
Lower extremity motor and/or sensory deficits were identified in 5.1% of preimplementation and 4.2% of postimplementation cases. SCI treatment interventions included increasing the mean arterial pressure (MAP) (66% pre and 100% post), placing lumbar drain (33% pre and 33% post), performing carotid subclavian bypass (33% pre and 33% post), initiating naloxone drip (66% pre and 100% post), and administering glipizide (0% pre and 100% post, P < .05). Long-term paralysis occurred in 66% of preimplementation and 0% of postimplementation cases.
CONCLUSIONS
By creating and implementing an SCI treatment algorithm we reduced both, time to detection and time to effective treatment of SCI and significantly improved our patients' neurological outcomes.
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