Early Cardiac Pacemaker Placement for Life-Threatening Bradycardia in Traumatic Spinal- Cord Injury
Journal of Trauma
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
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.
Moerman, Jacob R., Benjamin D. Christie, Leon N. Sykes, Robert L. Vogel, Tracy L. Nolan, Ashley W. Dennis.
"Early Cardiac Pacemaker Placement for Life-Threatening Bradycardia in Traumatic Spinal- Cord Injury."
Journal of Trauma, 70 (6): 1485-1488.