BACKGROUND: Spinal cord ischemia (SCI) is a devastating complication of thoracic and thoracoabdominal aortic aneurysm (TAAA) repair. We aim to characterize the current practices pertaining to SCI prevention and treatment across Canada.
METHODS AND RESULTS: Two questionnaires were developed by the Canadian Thoracic Aortic Collaborative and the Canadian Cardiovascular Critical Care Society targeting surgeons and cardiac ICU experts in the management of patients undergoing aortic surgery at risk of SCI. We obtained a 91% response rate from both intensivists and from cardiac and vascular surgeons. Most surgeons agreed that staging is important during endovascular repair of extent II TAAA (60%), but not for open repair (34%). There was 100% consensus among surgeons that prophylactic lumbar drains were effective in reducing SCI, while only 66.7% of intensivists felt that lumbar drains were effective (p < 0.001). There was >80% consensus among surgeons over various scenarios as to when to employ lumbar drains (Table 1). Fifty-four percent of surgeons thought that neuromonitoring was helpful. A majority of surgeons (74.4%) preferred to keep the hemoglobin over 100 g/L if the patient demonstrated loss of lower extremity function, while majority of ICU consultants (52.4%) felt a target of 80 g/L was adequate (p < 0.001). Management of perioperative anti-hypertensives, use of intra-operative adjuncts, and management of venous thromboembolism prophylaxis in the presence of a lumbar drain, were highly variable.
CONCLUSION: We observed some consensus but considerable variability in the approach to SCI prevention and management in experts across Canada. Future studies focused on the areas of variability may lead to more consistent and improved care for this high-risk population.