The available evidence to date regarding the non-pharmacological management of bradycardia in acute SCI has focused on the effectiveness of cardiac pacemaker placement.
Three studies have examined the implantation of cardiac pacemakers for the treatment of bradycardia during acute SCI. Rangappa et al. (2010) conducted a case control study to compare cervical SCI patients who required cardiac pacemaker implantation for management of bradycardia to those who did not necessitate this inervention. Pacemaker insertion occurred 9-17 days after injury. Compared to patients not requiring a cardiac pacemaker, patients who underwent pacemaker placement had bradycardic episodes over a significantly longer period of time (p=0.01) and a trend towards later bradycardic onset (p=0.05).
A case series by Franga et al. (2006) retrospectively reviewed five cervical SCI patients who developed recurrent bradyarrythmias requiring aggressive management and subsequently underwent cardiac pacemaker placement 16-36 days afer injury. The authors observed no symptomatic bradycardic events to occur following successful pacemaker placement. Lastly, in a case series by Moerman et al. (2011), 106 cervical SCI patients were reviewed from a trauma center registry. Of these patients, 14% were documented to have bradycardia, of which 47% underwent pacemaker placement. However, only 6 were deemed to have reviewable data and were included further in the study. The authors noted that cardiac pacemaker placement led to resolution of all bradycardic episodes.
There is level 4 evidence (from two case series; Moerman et al. 2011; Franga et al. 2006) that cardiac pacemaker implantation reduces bradycardic events in acute SCI patients.
Cardiac pacemaker implantation appears to be effective for the management of refractory bradycardia during the acute phase post SCI.