Table 1 List of consensus recommendations
N | Recommendation | Level |
|---|---|---|
1 | We recommend that all salvageable tSCI polytrauma patients with life-threatening conditions need immediate life support interventions (e.g., intubation, mechanical ventilation, hemodynamic support, extraspinal surgery/interventional radiology for bleeding control, etc.) | Strong recommendation |
2 | We recommend that tSCI polytrauma patients needing extracranial interventions (e.g., surgery, interventional radiology, etc.) for life-threatening conditions require careful positioning (protection and maintenance of spine alignment) to avoid secondary insults to the injured spine | Strong recommendation |
3 | We recommend that tSCI polytrauma patients, without life-threatening conditions or after cardiorespiratory stabilization, need urgent neurological evaluation and imaging (i.e., spine reconstruction from a whole-body CT scan) | Strong recommendation |
4 | We recommend, in tSCI polytrauma patients (without life-threatening conditions or after cardiorespiratory stabilization), to perform spine MRI after spinal specialist consultation to determine the severity of spinal cord damage and aid in surgical decision making | Strong recommendation |
5 | We recommend, in all salvageable tSCI polytrauma patients with surgical spinal lesions, after control of life-threatening conditions, to consider an urgent intervention (decompression/spine stabilization), possibly within 24 h from trauma | Strong recommendation |
6 | We recommend the maintenance of a MAP > 85 mmHg during interventions for life-threatening hemorrhage or emergency spinal surgery. In case of difficult intraoperative bleeding control, lower values could be tolerated for the shortest possible time | Strong recommendation |
7 | We recommend that the Hb level, during interventions for life-threatening hemorrhage or emergency spinal surgery, be adjusted according to a patient's tolerance to anemia. An Hb < 7 g/dl should promptly trigger RBCTs. A higher threshold for RBCTs could be used in patients "at risk" (e.g., elderly and/or with limited cardiovascular reserve because of pre-existing heart disease, etc.) | Strong recommendation |
8 | We recommend the maintenance of a PaO2 between 60 and 100 mmHg (7.9–13.3 kPa) during interventions for life-threatening hemorrhage or emergency spinal surgery | Strong recommendation |
9 | We recommend the maintenance of a PaCO2 between 35 and 40 mmHg (4.7–5.3 kPa) during interventions for life-threatening hemorrhage or emergency spinal surgery | Strong recommendation |
10 | In case of interventions for life-threatening hemorrhage, we recommend the maintenance of a PLT count > 50.000/mm3. In the case of spinal surgery (decompression/stabilization), a higher value (75.000–100.000/mm3) would be advisable | Strong recommendation |
11 | We recommend the maintenance of a PT/aPTT value < 1.5 normal control during interventions for life-threatening hemorrhage or emergency spinal surgery | Strong recommendation |
12 | We recommend, if available, the utilization of POC tests (e.g., TEG, ROTEM, etc.) to assess and optimize the coagulation function during interventions for life-threatening hemorrhage or emergency spinal surgery | Weak recommendation |
13 | We recommend the early reversal of anticoagulant/antiplatelet agents in all salvageable tSCI polytrauma patients needing interventions for life-threatening hemorrhage or emergency spinal surgery | Strong recommendation |
14 | In adult patients with tSCI and polytrauma, we recommend the transfusion of RBCs/Plasma/PLTs at a ratio of 1/1/1 during massive transfusion protocol initiation. Afterward, this ratio can be modified according to laboratory values | Strong recommendation |
15 | We recommend against high-dose corticosteroid therapy (e.g., NASCIS I-III) in tSCI patients and polytrauma | Strong recommendation |
16 | We recommend DVT prophylaxis with intermittent pneumatic compression devices (if available and feasible) as soon as possible after tSCI and polytrauma | Strong recommendation |
17 | We recommend a strict collaboration between the different medical specialties (e.g., critical care medicine, acute care surgery, neurosurgery, neurology, emergency medicine, orthopedics, etc.) involved in the early management of tSCI patients with polytrauma | Strong recommendation |