Spinal cord injury (SCI) happens suddenly when the spinal cord is crushed or cut, damaging cells and axons. However, most SCIs are not complete, and there may be spared tissue that could lead to recovery. Keeping the cord from any further damage in the minutes and hours following injury is critical. The spinal cord needs good blood flow to stay alive, but the injury blocks and damages blood vessels and leads to reduced flow, like a stroke. The spinal cord is important in controlling blood pressure, and SCI can lead to lowered blood pressure that robs the cord of needed oxygen, and may produce even more damage. One goal of early management of SCI has been to keep blood pressure from dropping. But drugs that increase blood pressure can be dangerous and might even cause more bleeding into the damage cord. Therefore, emergency treatment of SCI in the field and in the early period in transfer and in the hospital faces a dilemma. There simply isn't enough information on the relationship between blood pressure changes and good or bad outcomes after SCI to recommend guidelines for treatment. Most physicians treating SCI agree that this is a critical area for research, but getting the needed information is difficult.

We are proposing to gather crucial information on how SCI patients' blood pressure management affects their recovery by monitoring treatments and outcomes at three major centers in the San Francisco Bay Area. We will do parallel experiments on rats with SCI so that we can study the effects of low and high blood pressure on outcomes without endangering patients. This approach represents a bedside-to-bench and back again approach to providing simple guidelines for emergency treatment for SCI that can be applied to our wounded warriors, veterans, and the civilian population. Our centers have a unique, established collaboration between experimental SCI scientists and world-class SCI physicians and have the capacity to get the best information possible to resolve this dilemma.

The results of this research will be applicable to all types of SCI patients at the earliest stages of injury, since blood pressure is a key vital sign that is measured immediately and continuously in the field and the hospital, and there are a variety of ways to control it. The information gained from this work could be immediately applied to the treatment of SCI without need for FDA approval or the development of new drugs or devices. Further, guidelines could be implemented at all levels of trauma treatment.

This research will provide new information on what current clinical practice is, and how it affects outcomes after SCI, and will link this information with experimental laboratory data on a well-characterized model of SCI in rats. The project will have immediate clinical impact while also clarifying issues on early management that need to be studied further in the laboratory.