Cardiac pacing in patients with a cervical spinal cord injury.

Abstract

STUDY DESIGN:

Retrospective medical record review.

OBJECTIVES:

To compare patients, admitted to an intensive care unit (ICU) with an acute cervical spinal cord injury (SCI) and documented motor deficit, who did, with those who did not, require a cardiac pacemaker.

SETTING:

South Australian Tertiary Referral Intensive Care and Spinal Injury Unit.

METHODS:

Retrospective medical record review and data set linkage.

RESULTS:

From 1995 to 2007, 465 patients sustained a cervical SCI. Of these, 30 (6.5%) were admitted to ICU with a clinically assessable motor deficit and 3 (0.6% of all patients, or 10% of those admitted to ICU) required a cardiac pacemaker. All three patients had a cervical SCI, C5 (American Spinal Injury Association A) tetraplegia, and required invasive mechanical respiratory and inotropic support and a tracheostomy for weaning. Two patients (66%) were discharged alive to rehabilitation. Patients requiring a pacemaker had bradycardic episodes over a longer period (11 vs 4 days, P=0.01), a trend towards a later onset of bradycardia (8 vs 1.5 days, P=0.05) and a longer ICU length of stay (37 vs 10 days, P=0.02).

CONCLUSION:

Patients with a cervical SCI requiring a cardiac pacemaker are characterized by a higher level of SCI injury and motor loss, require mechanical respiratory and inotropic support, a tracheostomy to wean, and bradycardic episodes of a later onset and over a longer period of time. These findings suggest that such patients should be managed at hospitals with specialized acute spinal injury, intensive care and cardiac pacemaker services.

• Authors: P Rangappa, J Jeyadoss, A Flabouris, J M Clark, R Marshall
• Journal: Spinal cord (Spinal Cord) Vol. 48 Issue 12 Pg. 867-71 (Dec 2010) ISSN: 1476-5624 [Electronic] England
• PMID: 20498664 (Publication Type: Journal Article)

Topics

• Adult
• Bradycardia (etiology, therapy)
• Cardiac Pacing, Artificial
• Cervical Vertebrae
• Female
• Humans
• Intensive Care Units
• Length of Stay
• Male
• Paralysis (etiology)
• Retrospective Studies
• Spinal Cord Injuries (complications, physiopathology)