Management of Hyperthermia and Hypotension in Cervical Spinal Cord Injury

Critical Temperature Management

The American College of Surgeons recommends preventing hypothermia as the primary temperature concern in acute cervical spinal cord injury, while hypotension must be aggressively managed with volume resuscitation first, targeting systolic blood pressure >110 mmHg initially and mean arterial pressure ≥70 mmHg during the first week 1, 2
Hypothermia dramatically increases mortality and morbidity in cervical spinal cord injury patients, with each 1°C drop in temperature reducing coagulation factor function by 10%, and temperatures below 34°C are associated with >80% mortality risk 3
The Society of Critical Care Medicine recommends removing all wet clothing immediately and covering the patient to prevent additional heat loss, increasing ambient temperature in the treatment area, applying forced air warming devices as first-line active warming, and administering only warm intravenous fluids to target normothermia: core temperature 36-37°C 3, 2

The American Heart Association recommends maintaining systolic blood pressure >110 mmHg during initial assessment to reduce mortality, and targeting mean arterial pressure ≥70 mmHg continuously during the first week post-injury to limit neurological deterioration 1, 4
The European Society of Anaesthesiology recommends using continuous arterial line monitoring, as maintaining these targets is difficult, and administering warm crystalloid or blood products as indicated for volume resuscitation, never using cold intravenous fluids 1, 2
The American College of Emergency Physicians recommends using vasopressors only transiently if life-threatening hypotension persists despite adequate volume resuscitation, with norepinephrine as the vasopressor of choice, and assessing cardiac function with ultrasound before escalating vasopressors 2

The American Society of Anesthesiologists recommends using manual in-line stabilization with removal of anterior cervical collar during intubation to improve glottic exposure while protecting the spine, and employing rapid sequence induction with direct laryngoscopy and gum elastic bougie without Sellick maneuver 6, 7, 4

The Centers for Disease Control and Prevention recommends direct admission to Level 1 trauma centers within the first hours to reduce morbidity, mortality, and improve neurological outcomes 1, 4