Immediate Cooling followed by Emergency Decompression for the treatment of traumatic cervical SCI
Funded in: 2018, 2019, 2020
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Problem: Time for transportation and investigation delays the urgent decompression, thereby impairing the outcome.
Target: To expand the time frame for surgery to a more realistic and achievable time.
Goal: To improve recovery following spinal injury.
Most victims of acute traumatic spinal cord injury (SCI) are young and the majority have severe paralysis. At present, there is no specific treatment for patients with acute spinal cord injury. Even a limited ability to improve outcomes in this group of patients would greatly ease the burden of disease.
Injury to the spinal cord occurs not just at the time of impact, but also results from compression of the spinal cord as a consequence of broken and displaced vertebrae in the spine. Previous studies suggest that urgent relief of compression with surgery appears to improve patient recovery and outcome. However, urgent surgery is difficult to achieve because of the time occupied by transportation, investigation, and stabilisation of the patient as well as the organisation of surgery. Cooling (hypothermia) can suspend the progressive damage caused to the spinal cord by compression, thereby allowing surgery to be performed in a more achievable time frame.
The aim of this research project is to determine whether it is possible to cool patients with spinal cord injuries resulting from neck trauma (cervical SCI) in the first hours after injury. This study will also determine whether it is feasible to operate on patients early after injury. Selected patients will be cooled within 2 hours of injury and rapidly transported to theatre to undergo surgical decompression within 8 hours.
We hope this project will provide evidence that it is safe to cool patients with a cervical spinal cord injury and also that emergency surgery in these patients is achievable. The combination of cooling and early decompression surgery has the potential to improve recovery following spinal injury. Results from this project will allow us to commence a multi-centre randomised controlled trial.