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.

Cardiac pacemaker implantation appears to be effective for the management of refractory bradycardia during the acute phase post SCI.

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