Multicenter analysis of diaphragm pacing in tetraplegics with cardiac pacemakers: positive implications for ventilator weaning in intensive care units.
BACKGROUND
Diaphragm pacing (DP) can replace mechanical ventilation in tetraplegics and in trials has assisted respiration in amyotrophic lateral sclerosis patients. This report describes results of DP in patients with cardiac pacemakers.


METHODS
Prospective, single-center and multicenter, nonrandomized, controlled, interventional protocols under U.S. Food and Drug Administration and/or institutional review board approval were evaluated. Patients underwent laparoscopic diaphragm motor point mapping to identify optimal electrode site for implantation. With diaphragm conditioning, patients were weaned from their ventilator. Perioperative and long-term assessments between the cardiac pacemakers and DP were analyzed for any device-to-device interactions.


RESULTS
Over 300 subjects were implanted from 2000 to 2010. Twenty tetraplegics with cardiac pacemakers and DP were analyzed from 6 sites. Subjects ranged from 19 to 61 years old with DP implantation 6 months to 24 years postinjury. There were no immediate or long-term device to device interactions. All patients achieved diaphragm-paced tidal volumes exceeding their basal requirements and, after conditioning, all patients could go >4 hours without mechanical ventilators; 71% could go 24 hours continuously.


CONCLUSIONS
DP can be safely implanted in tetraplegics having cardiac pacemakers. Applications for temporary use of DP to maintain diaphragm type 1 muscle fiber and improve posterior lobe ventilation may benefit complex critical care patients.
Onders
Raymond P
RP
Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH, USA. Raymond.onders@uhhospitals.org
Khansarinia
Saeid
S
Weiser
Todd
T
Chin
Cynthia
C
Hungness
Eric
E
Soper
Nathaniel
N
Dehoyos
Alberto
A
Cole
Tim
T
Ducko
Christopher
C
D000328:Adult; D003964:Diaphragm; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011782:Quadriplegia / Q000209:etiology*; D012121:Respiration, Artificial; D012133:Respiratory Paralysis / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*; D055815:Young Adult