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Cardiovascular Complications (Acute Phase)

Surgical Interventions

Evidence for non-pharmacological management of bradycardia in acute SCI has been surgical and focuses on the effectiveness of cardiac pacemaker placement.

Author Year; Country
Research Design
Sample Size
Methods Outcome

Moerman et al. 2011; USA
Case Series
N = 106

Population: Mean age=46 yr; Gender: males=6, females=0; Level of injury: C2 to C7-T1; Severity of injury: average Injury Severity Score (ISS)=50 (21-75).
Intervention: Retrospective review of cervical SCI patients from a trauma center registry to assess those necessitating cardiac pacemaker placement.
Outcome Measures: Incidence of bradycardia; Resolution of bradyarrythmias/asystolic events.
Chronicity: Time from admission to placement of cardiac pacemaker was 7-24 days (mean=11.5 days).
  1. 15 (14%) patients had bradycardia.
  2. Initial episodes of bradycardia occurred 3-9 days after admission (mean=5.7 days).
  3. 7 (47%) patients underwent pacemaker placement; 6 had reviewable data and were included in the study.
  4. Cardiac pacemaker placement led to resolution of all bradycardic episodes.

Franga et al. 2006; USA
Case Series
N = 30

Population: Mean age=38 yr; Gender: males=3, females=2; Level of injury: cervical, high (C1-C5) or low (C6-C7); Severity of injury: complete.
Intervention: Retrospective review of cervical SCI patients from a trauma database who developed recurrent bradyarrythmias requiring aggressive medical management and cardiac pacemaker implantation.
Outcome Measures: Incidence of bradycardia; Resolution of bradyarrythmias/asystolic events.
Chronicity: Patients underwent pacemaker placement 16-36 days after injury.
  1. 5 of 30 (17%) patients developed recurrent bradyarrythmias and/or asystole and underwent cardiac pacemaker implantation.
  2. No symptomatic bradycardic/asystolic events were noted after successful pacemaker placement.

Discussion

Two studies examined the implantation of cardiac pacemakers for the treatment of bradycardia during acute SCI. 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. No symptomatic bradycardic events occurred following successful pacemaker placement. In another 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; in these cardiac pacemaker placement led to resolution of all bradycardic episodes.

Conclusion

There is level 4 evidence (from two case series: Moerman et al. 2011; Franga et al. 2006) that cardiac pacemaker implantation eliminates bradycardic events in acute SCI patients.

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