title: Early cardiac pacemaker placement for life-threatening bradycardia in traumatic spinal cord injury.
abstract: BACKGROUND
  High cervical spinal cord injury (CSCI) can cause life-threatening bradycardia from autonomic instability that may be resistant to pharmacologic interventions. Placement of a cardiac pacemaker, traditionally reserved for patients refractory to drug therapy, may be lifesaving.
  
  
  METHODS
  Our Level I trauma center registry found all patients with CSCI from 2003 to 2009. A retrospective chart review identified major events involving the circulatory system: those exhibiting bradycardia (minor, heart rate 40-60/min; major, heart rate <40/min), hypotension (systolic blood pressure <80 mm Hg), asystole, and cardiac arrest. Records of pharmacological interventions (e.g., atropine) and details of pacemaker placement (e.g., timing and any complications) were reviewed. Statistical differences were determined by Wilcoxon signed-rank test, with p < 0.05 as significant.
  
  
  RESULTS
  Of the 106 patients with CSCI, 15 (14%) had bradycardia and 7 of those (47%) underwent cardiac pacemaker placement. Six of seven patients had reviewable data. A total of 35 events occurred in these six patients before pacemaker placement. Subsequent to placement, there were zero events of cardiovascular instability (p = 0.0135). Major bradycardic episodes were reduced from 9 to 0 (p = 0.0206) and incidents requiring atropine administration from 9 to 0 (p = 0.0197). Four survived; two patients died from pulmonary complications. There were no complications related to pacemaker insertion.
  
  
  CONCLUSIONS
  Patients with CSCI life-threatening complications of bradycardia benefit from early placement of a cardiac pacemaker. Early stabilization may facilitate transfer out of the intensive care unit, mobilization, physical therapy, rehabilitation, and outcome.
authors.affiliation: Trauma and Surgical Critical Care Services, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia 31201, USA.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Moerman
authors.forename: Benjamin  D
authors.initials: B
authors.lastname: Christie
authors.forename: Leon N
authors.initials: LN
authors.lastname: Sykes
authors.forename: Robert L
authors.initials: RL
authors.lastname: Vogel
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Nolan
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Ashley
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012042:Registries; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome