Diaphragmatic pacing after cervical spinal cord injury due to gunshot wound: a 14-year institutional experience

Purpose

High cervical spinal cord injury (SCI) due to gunshot wound (GSW) represents an extremely devastating injury class not only due to quadriplegia, but also the high incidence of chronic mechanical ventilation (MV) due to injury to the spinal nerves that innervate the diaphragm. Diaphragmatic pacemaker (DP) implantation is a potential option to liberate individuals from chronic MV by assisting with diaphragm contraction and therefore improving respiratory function.

Methods

We conducted a retrospective chart review at our institution to identify patients with high cervical SCI due to GSW who underwent DP implantation and had 6 months or more of clinical follow-up.

Results

Fourteen patients were included for chart review. Twelve patients were male; 9 were African American. Twelve had complete (ASIA A) SCI, of whom 7 had an injury at or above C3. Six of 12 (50%) patients whose MV status was documented achieved 4 h and 24 h per day of MV independence. All patients in whom detailed respiratory function data could be attained showed percentage tidal volumes over baseline requirement (PTVOB) greater than 100% (median:151.9%).

Conclusion

Consistent with previously published data, DP implantation for SCI due to GSW seems to have benefit with regard to MV independence and other respiratory metrics. This held true regardless of injury level or whether the DP was implanted during index hospitalization or in a delayed fashion. DP implantation is a viable option to consider in patients with high cervical SCI after GSW in both the acute and chronic setting to grant patients a potential for MV liberation.