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There is limited evidence to date regarding pharmacological interventions used for the management of bradycardia in acute SCI. Only two studies have been found which investigated albuterol as treatment for bradycardia in acute SCI patients. However, the effectiveness of other pharmacological agents (aminophylline and theophylline) for acute bradycardia post SCI has been studied in case reports which did not meet our inclusion criteria (Pasnoori & Leesar, 2004; Sadaka et al., 2010; Schulz-Stubner, 2005; Whitman et al., 2008).

Table 6. Oral Albuterol for Treatment of Badycardia in Acute SCI

Author Year

Country

Research Design

Sample Size

MethodsOutcomes
Rollstin et al., (2016)

United States

Case Series

N=11

Population: Mean age: 48yr; Gender: males=9, females=2; Mean time post injury= 10 days; Severity of injury: ASIA: A=7, B=3, unknown=1.

Interventions: Oral albuterol

Outcome Measures: Incidence of bradycardic events.

1.     Patients had significantly fewer bradycardic events after albuterol initiation (p=0.013).
Evans et al., (2014)

USA

Case Control

N=18

Population: Median age=49yr (albuterol group), median age=51 yr (no-albuterol group); Gender: males=75%, females=25% (albuterol group), males=80%, females=20% (no-albuterol group); Level of injury: C5 or higher (n=7, albuterol group), C5 or higher (n=7, no-albuterol group); Severity of injury: median injury severity score (ISS)=36.5, AIS A-C (albuterol group), median ISS=26, AIS A-B (no albuterol group).

Intervention: Retrospective review of cervical SCI patients from a trauma center comparing those who were given (albuterol group) versus those who were not given (no-albuterol group) oral albuterol.

Outcome Measures: Incidence of bradycardia; Hospital days requiring chronotropic use; Total atropine administered.

Chronicity: Patients receiving albuterol were treated for a median of 5 days (range: 1-116 days); Patients not receiving albuterol were monitored for the initial 2wk of hospitalization.

1.     All patients developed bradycardia: time to bradycardic episode was 0-13 days in the albuterol group, and 0-23 days in the no-albuterol group.

2.     The median number of bradycardic episodes was significantly lower in patients receiving albuterol versus those not receiving albuterol (1.8 versus 4.3, p=0.08).

3.     Hospital days on chronotropic agents were significantly lower in patients receiving albuterol versus those not receiving albuterol (0 versus 5.5, p=0.05).

4.     The median total of atropine administered was significantly higher in patients not receiving albuterol versus those receiving albuterol (1 mg versus 0 mg, p=0.013).

Discussion

Two studies investigated the effectiveness of oral albuterol for treatment of bradycardia during acute SCI. Evans et al. (2014) conducted a case control study in which 18 patients with cervical SCI were retrospectively reviewed; 8 patients who were treated with oral albuterol during hospitalization following injury were compared to 10 patients not given this treatment. All patients developed bradycardia, however the median of bradycardic episodes was significantly lower (1.8) in patients receiving albuterol compared to patients not receiving albuterol (4.3, p=0.08). The authors also noted that the median total of atropine administered was significantly lower in patients given albuterol (0 mg) than in patients not given albuterol (1 mg, p=0.013). Rollistin et al. (2016) similarly found that patients given oral albuterol when compared to baseline assessment, had significantly fewer episodes of bradycardic events.

Conclusion

There is level 3 evidence (from one case control; Evans et al., 2014) that oral albuterol reduces bradycardic episodes in acute SCI patients.

Oral albuterol appears to be effective for the management of bradycardia during the acute phase post SCI.