The objective of this guideline was to update the 2013 AANS/CNS recommendations on the hemodynamic management of acute spinal cord injury (SCI) by establishing recommendations on the mean arterial pressure (MAP) target range, the duration of MAP augmentation and the choice of vasopressor. 

A guideline development group (GDG) was formed that included healthcare professionals from a wide range of clinical specialities, patient advocates and individuals living with SCI. A systematic review was conducted to inform the guideline development process and summarize the evidence on the impact of MAP augmentation on neurologic recovery and rates of adverse events. Using GRADE, the GDG combined the information from this systematic review with their clinical expertise in order to develop recommendations on a MAP target range, the optimal duration for MAP augmentation and the use of vasopressors.

The GDG suggested that MAP be augmented to at least 75-80mmHg but not higher than 90-95mmHg in order to optimize spinal cord perfusion in acute SCI.    For duration, the GDG suggested that MAP be augmented for 3-7 days after injury. Given the quality of evidence was very low, the strength of these recommendations was weak. The GDG agreed that a recommendation on the choice of vasopressor was not warranted, given the available evidence. 

These guidelines provide new recommendations for blood pressure management after acute SCI, while acknowledging the limitations in the current evidence on the relationship between MAP and neurologic recovery. Although important knowledge gaps still remain in the area of hemodynamic management, these recommendations represent current perspectives on the role of MAP augmentation for acute SCI.