open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-05-05
Submitted: 2017-12-15
Accepted: 2018-03-22
Get Citation

Hyperbaric oxygen therapy for spinal cord ischaemia after complex aortic repair — a retrospective review

Matteo Parotto, Maral Ouzounian, Ludwik Fedorko, George Oreopoulos, Thomas Lindsay, Rita Katznelson
DOI: 10.5603/AIT.a2018.0010
·
Pubmed: 29882580
·
Anaesthesiol Intensive Ther 2018;50(2):103-109.

open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-05-05
Submitted: 2017-12-15
Accepted: 2018-03-22

Abstract

Background: Complex aortic repair (CAR) carries high rates of debilitating postoperative complications, including spinal cord injury. The rate of spinal cord deficits post-CAR is approximately 10%, with permanent paraplegia in 2.9% and paraparesis in 2.4% of patients. Treatment options are limited. Rescue therapies include optimization of spinal cord perfusion and oxygen delivery by mean arterial pressure augmentation (> 90 mm Hg), cerebrospinal fluid drainage, and preservation of adequate haemoglobin concentration (> 100 g L-1). Hyperbaric oxygen therapy (HBOT) has been described in several case reports as part of the multimodal treatment for spinal cord ischemia. HBOT has been used in our centre as adjunct rescue treatment for patients with spinal cord injury post-CAR that were refractory to traditional medical management, and we aimed to retrospectively review these cases.

Methods: After Research Ethics Board approval, we performed a retrospective review of all post-CAR patients who developed spinal cord injury with severe motor deficit and were treated with HBOT at our institution since 2013.

Results: Seven patients with spinal cord injury after CAR were treated with HBOT in addition to traditional rescue therapies. Five patients showed varying degrees of recovery, with two displaying full recovery. One developed oxygen-induced seizure, medically treated. No other HBOT-related complications were noted.

Conclusions: Our retrospective study shows a potential benefit of hyperbaric oxygen therapy on neurological outcome in patients who developed spinal cord injury after CAR. Prospective research is needed to understand the role, efficacy, benefits and risks of HBOT in this setting.

Abstract

Background: Complex aortic repair (CAR) carries high rates of debilitating postoperative complications, including spinal cord injury. The rate of spinal cord deficits post-CAR is approximately 10%, with permanent paraplegia in 2.9% and paraparesis in 2.4% of patients. Treatment options are limited. Rescue therapies include optimization of spinal cord perfusion and oxygen delivery by mean arterial pressure augmentation (> 90 mm Hg), cerebrospinal fluid drainage, and preservation of adequate haemoglobin concentration (> 100 g L-1). Hyperbaric oxygen therapy (HBOT) has been described in several case reports as part of the multimodal treatment for spinal cord ischemia. HBOT has been used in our centre as adjunct rescue treatment for patients with spinal cord injury post-CAR that were refractory to traditional medical management, and we aimed to retrospectively review these cases.

Methods: After Research Ethics Board approval, we performed a retrospective review of all post-CAR patients who developed spinal cord injury with severe motor deficit and were treated with HBOT at our institution since 2013.

Results: Seven patients with spinal cord injury after CAR were treated with HBOT in addition to traditional rescue therapies. Five patients showed varying degrees of recovery, with two displaying full recovery. One developed oxygen-induced seizure, medically treated. No other HBOT-related complications were noted.

Conclusions: Our retrospective study shows a potential benefit of hyperbaric oxygen therapy on neurological outcome in patients who developed spinal cord injury after CAR. Prospective research is needed to understand the role, efficacy, benefits and risks of HBOT in this setting.

Get Citation

Keywords

spinal cord ischaemia, hyperbaric oxygen therapy, aortic aneurysm

Supplementary Files (1)
Title Page
Download
13KB
About this article
Title

Hyperbaric oxygen therapy for spinal cord ischaemia after complex aortic repair — a retrospective review

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 2 (2018)

Pages

103-109

Published online

2018-05-05

DOI

10.5603/AIT.a2018.0010

Pubmed

29882580

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(2):103-109.

Keywords

spinal cord ischaemia
hyperbaric oxygen therapy
aortic aneurysm

Authors

Matteo Parotto
Maral Ouzounian
Ludwik Fedorko
George Oreopoulos
Thomas Lindsay
Rita Katznelson

References (25)
  1. Juvonen T, Ergin MA, Galla JD, et al. Prospective study of the natural history of thoracic aortic aneurysms. Ann Thorac Surg. 1997; 63(6): 1533–1545.
  2. Coselli JS, LeMaire SA, Preventza O, et al. Outcomes of 3309 thoracoabdominal aortic aneurysm repairs. J Thorac Cardiovasc Surg. 2016; 151(5): 1323–1337.
  3. Crawford ES, Svensson LG, Hess KR, et al. A prospective randomized study of cerebrospinal fluid drainage to prevent paraplegia after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg. 1991; 13(1): 36–45; discussion 45.
  4. Svensson LG, Crawford ES, Hess KR, et al. Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993; 17(2): 357–68; discussion 368.
  5. Chaikof EL, Salam AA. Neurologic complications of abdominal aortic reconstruction. In: Ernst CB, Stanley JC, editors. Current therapy in vascular surgery. 3rd ed. St Louis: Mosby-Year Book, Inc. ; 1995: 278–82.
  6. Wynn MM, Acher CW. A modern theory of spinal cord ischemia/injury in thoracoabdominal aortic surgery and its implications for prevention of paralysis. J Cardiothorac Vasc Anesth. 2014; 28(4): 1088–1099.
  7. Rosenthal D. Spinal cord ischemia after abdominal aortic operation: is it preventable? J Vasc Surg. 1999; 30(3): 391–397.
  8. Venetsanou K, Fildissis G, Tokta R, et al. The role of nitric oxide in cellular response to hyperbaric conditions. Eur J Appl Physiol. 2012; 112(2): 677–687.
  9. Al-Waili NS, Butler GJ. Effects of hyperbaric oxygen on inflammatory response to wound and trauma: possible mechanism of action. ScientificWorldJournal. 2006; 6: 425–441.
  10. Puttaswamy V, Bennett M, Frawley JE. Hyperbaric oxygenation treatment of acute paraplegia after resection of a thoracoabdominal aortic aneurysm. J Vasc Surg. 1999; 30(6): 1158–1161.
  11. Wajima Z, Aida S. Does hyperbaric oxygen have positive effect on neurological recovery in spinal-epidural haematoma? A case report. Br J Anaesth. 2011; 107(6): 1006–1008.
  12. Kohshi K, Abe H, Mizoguchi Y, et al. Successful treatment of cervical spinal epidural abscess by combined hyperbaric oxygenation. Mt Sinai J Med. 2005; 72(6): 381–384.
  13. Lee K, Strozyk D, Rahman C, et al. Acute spinal cord ischemia: treatment with intravenous and intra-arterial thrombolysis, hyperbaric oxygen and hypothermia. Cerebrovasc Dis. 2010; 29(1): 95–98.
  14. Yamashiro S, Kuniyoshi Y, Miyagi K, et al. Acute postoperative paraplegia complicating with emergency graft replacement of the ascending aorta for the type a dissection. Ann Thorac Cardiovasc Surg. 2003; 9(5): 330–333.
  15. Morishita A, Tomioka H, Katahira S, et al. Delayed visceral and spinal cord malperfusion after axillo-bifemoral bypass for complicated acute type B aortic dissection. Ann Vasc Dis. 2014; 7(3): 331–334.
  16. Topuz K, Colak A, Cemil B, et al. Combined hyperbaric oxygen and hypothermia treatment on oxidative stress parameters after spinal cord injury: an experimental study. Arch Med Res. 2010; 41(7): 506–512.
  17. Geng CK, Cao HH, Ying X, et al. Effect of mesenchymal stem cells transplantation combining with hyperbaric oxygen therapy on rehabilitation of rat spinal cord injury. Asian Pac J Trop Med. 2015; 8(6): 468–473.
  18. Tai PA, Chang CK, Niu KC, et al. Attenuating experimental spinal cord injury by hyperbaric oxygen: stimulating production of vasculoendothelial and glial cell line-derived neurotrophic growth factors and interleukin-10. J Neurotrauma. 2010; 27(6): 1121–1127.
  19. Zhou Yi, Liu Xh, Qu Sd, et al. Hyperbaric oxygen intervention on expression of hypoxia-inducible factor-1α and vascular endothelial growth factor in spinal cord injury models in rats. Chin Med J (Engl). 2013; 126(20): 3897–3903.
  20. Liu X, Zhou Yi, Wang Z, et al. Effect of VEGF and CX43 on the promotion of neurological recovery by hyperbaric oxygen treatment in spinal cord-injured rats. Spine J. 2014; 14(1): 119–127.
  21. Huang H, Xue L, Zhang Xu, et al. Hyperbaric oxygen therapy provides neuroprotection following spinal cord injury in a rat model. Int J Clin Exp Pathol. 2013; 6(7): 1337–1342.
  22. Geng CK, Cao HH, Ying X, et al. The effects of hyperbaric oxygen on macrophage polarization after rat spinal cord injury. Brain Res. 2015; 1606: 68–76.
  23. Yang J, Liu X, Zhou Yi, et al. Hyperbaric oxygen alleviates experimental (spinal cord) injury by downregulating HMGB1/NF-κB expression. Spine (Phila Pa 1976). 2013; 38(26): E1641–E1648.
  24. Tan J, Zhang F, Liang F, et al. Protective effects of hyperbaric oxygen treatment against spinal cord injury in rats via toll-like receptor 2/nuclear factor-κB signaling. Int J Clin Exp Pathol. 2014; 7(5): 1911–1919.
  25. Wang Y, Zhang S, Luo M, et al. Hyperbaric oxygen therapy improves local microenvironment after spinal cord injury. Neural Regen Res. 2014; 9(24): 2182–2188.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl