BACKGROUND: High cervical spinal cord injury (CSCI) can cause life-threatening bradycardia from autonomic instability that may be resistant to pharmacologic interventions. Placement of a cardiac pacemaker, traditionally reserved for patients refractory to drug therapy, may be lifesaving. METHODS: Our Level I trauma center registry found all patients with CSCI from 2003 to 2009. A retrospective chart review identified major events involving the circulatory system: those exhibiting bradycardia (minor, heart rate 40-60/min; major, heart rate <40/min), hypotension (systolic blood pressure <80 mm Hg), asystole, and cardiac arrest. Records of pharmacological interventions (e.g., atropine) and details of pacemaker placement (e.g., timing and any complications) were reviewed. Statistical differences were determined by Wilcoxon signed-rank test, with p < 0.05 as significant. RESULTS: Of the 106 patients with CSCI, 15 (14%) had bradycardia and 7 of those (47%) underwent cardiac pacemaker placement. Six of seven patients had reviewable data. A total of 35 events occurred in these six patients before pacemaker placement. Subsequent to placement, there were zero events of cardiovascular instability (p = 0.0135). Major bradycardic episodes were reduced from 9 to 0 (p = 0.0206) and incidents requiring atropine administration from 9 to 0 (p = 0.0197). Four survived; two patients died from pulmonary complications. There were no complications related to pacemaker insertion. CONCLUSIONS: Patients with CSCI life-threatening complications of bradycardia benefit from early placement of a cardiac pacemaker. Early stabilization may facilitate transfer out of the intensive care unit, mobilization, physical therapy, rehabilitation, and outcome.
BACKGROUND: High cervical spinal cord injury (CSCI) can cause life-threatening bradycardia from autonomic instability that may be resistant to pharmacologic interventions. Placement of a cardiac pacemaker, traditionally reserved for patients refractory to drug therapy, may be lifesaving. METHODS: Our Level I trauma center registry found all patients with CSCI from 2003 to 2009. A retrospective chart review identified major events involving the circulatory system: those exhibiting bradycardia (minor, heart rate 40-60/min; major, heart rate <40/min), hypotension (systolic blood pressure <80 mm Hg), asystole, and cardiac arrest. Records of pharmacological interventions (e.g., atropine) and details of pacemaker placement (e.g., timing and any complications) were reviewed. Statistical differences were determined by Wilcoxon signed-rank test, with p < 0.05 as significant. RESULTS: Of the 106 patients with CSCI, 15 (14%) had bradycardia and 7 of those (47%) underwent cardiac pacemaker placement. Six of seven patients had reviewable data. A total of 35 events occurred in these six patients before pacemaker placement. Subsequent to placement, there were zero events of cardiovascular instability (p = 0.0135). Major bradycardic episodes were reduced from 9 to 0 (p = 0.0206) and incidents requiring atropine administration from 9 to 0 (p = 0.0197). Four survived; two patients died from pulmonary complications. There were no complications related to pacemaker insertion. CONCLUSIONS:Patients with CSCI life-threatening complications of bradycardia benefit from early placement of a cardiac pacemaker. Early stabilization may facilitate transfer out of the intensive care unit, mobilization, physical therapy, rehabilitation, and outcome.
Authors: Amber Rollstin; Michael C Carey; Gloria Doherty; Isaac Tawil; Jonathan Marinaro Journal: Intern Emerg Med Date: 2015-10-05 Impact factor: 3.397
Authors: Sven Magnus Hector; Tor Biering-Sørensen; Andrei Krassioukov; Fin Biering-Sørensen Journal: J Spinal Cord Med Date: 2013-04-11 Impact factor: 1.985