47570 Early Hypertonic Saline Infusion is Associated With Superior Neurologic Outcome Following Acute Traumatic Spinal Cord Injury

INTRODUCTION: Few interventions have been shown to substantially modify neurologic outcome following acute traumatic spinal cord injury (SCI). Hyperosmolar therapy is an important adjunct in the treatment of traumatic brain injury (TBI); despite presumed overlap in the pathophysiology of SCI and TBI, there is no literature supporting the use of hyperosmolar therapy for acute SCI patients. METHODS: We performed a retrospective cohort study of SCI patients presenting to our institution between 2005 and 2020. We identified all patients admitted to our neurologic ICU between 2005 and 2020 with a new diagnosis of isolated SCI. We identified 143 patients for analysis. All patients either did or did not receive 3% hypertonic saline (HTS, 3% NaCl) at the discretion of the treatment team during index hospitalization. Primary outcomes were change in ASIA motor score and ASIA Impairment Scale at discharge. Secondary outcomes included intensive care unit length of stay (LOS), and hospital LOS. RESULTS: Administration of HTS within 18 hours of admission was associated with increased strength below injury (+21.0%, p<0.0001) and AIS grade improvement (+0.97 grade, p=0.004) compared to late (≥18 hours after admission) or no HTS administration. These effects seem to be strongest in patients admitted ASIA A (p=.001). There were no significant differences in ICU or total hospital LOS between subgroups. CONCLUSIONS: Our data identify 3% hypertonic saline as a potentially useful adjunctive therapy in early management of acute traumatic spinal cord injury. We hypothesize that by limiting edema and augmenting intravascular volume, HTS could limit secondary injury cascades by improving perfusion in the injury penumbra. This adds to mounting evidence that cranial neurotrauma principles applied to management of cord injury could result in superior outcomes.