The acute impact of spinal cord injury on cardiac function, and novel hemodynamic management in SCI patients

Following acute spinal cord injury (SCI), one of the only presently available neuroprotective strategies is to try and optimize management of spinal cord blood flow. This treatment specifically aims to immediately increase blood flow to the injured spinal cord tissue to prevent the spread of injury to surrounding spinal cord tissues.
Currently, vasopressors are administered to increase blood pressure to a similar threshold in all patients; however, its efficacy in improving neurological outcomes has not been consistent, and in some patients has been found to actually worsen outcomes. A more optimized and individualized approach to blood flow management in SCI patients is needed.

High-thoracic SCI immediately impairs the brainstem and neural control of the heart. Our pilot data suggest this decentralization of the heart immediately impairs cardiac function, which could have significant implications for the acute management of blood flow in SCI patients. Dr. Williams will investigate the immediate and acute cardiac responses to high-thoracic SCI, and determine whether improvements to cardiac function can improve spinal cord blood flow and neurological outcomes in SCI patients.

Dr. Williams will conduct translational studies utilizing a porcine model of SCI. She will test the efficacy of potential novel management strategies, including restoring cardiac function alone or in combination with vasopressor therapy. A simultaneous study will look at acutely injured individuals with SCI at Vancouver General Hospital, examining heart function during the first three days after injury.

To date, very little work has characterized the impact of SCI on cardiac function in the initial period following injury. Combining invasive and integrative studies in pigs and humans provides us with the unique opportunity to conduct highly translatable studies that could have an immediate impact on SCI patient outcomes.

 

End of Award Update – July 2022

Most exciting outputs
Our research to date has identified how high-level spinal cord injuries (i.e. at or above the mid-back level) impact the heart immediately after the injury occurs. We found that those injuries impact the heart’s output within the first hours post-injury, and further identified a treatment that could harness the heart to support blood pressure and potentially reduce secondary damage to the spinal cord.

 

Impacts so far
The award has allowed us to examine alternative approaches to treating acute spinal cord injury which could ultimately improve outcomes if that approach is effective in the clinical setting. Moreover, as a trainee this award has provided the critical opportunity for me to expand my skillset in the realms of clinical and pre-clinical research, and apply gold-standard techniques to answer questions about the heart that have traditionally been overlooked in the field of spinal cord injury research.

 

Potential future influence
With the support of this award I have made significant strides in my training toward becoming an established cardiovascular researcher. First, it has allowed me to expand my expertise in the heart and its neural control. Second, I have gained invaluable experience in clinical and pre-clinical research, which truly round out my training as a physiologist. Finally, I have been able to produce and output impactful research across those domains and in doing so built strong collaborations with local and international leaders in these respective fields.

 

Next steps
We have yet to publish additional research that has stemmed from this award, looking at the long-term benefits of heart-focused approaches to treating spinal cord injury, and would like to pursue opportunities to implement such an approach in the clinical setting.

 

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