Disclosures: Austin M. Boos, DO: No financial relationships or conflicts of interest

Case Diagnosis: 19-year-old male with ventilator dependency in the setting of a traumatic C4 ASIA A spinal cord injury, successfully bridged to independent respiration with early implementation of a diaphragmatic pacemaker.

Case Description or Program Description: Patient presented with complete tetraplegia requiring mechanical ventilation, after a motor vehicle accident. Due to prolonged ventilatory needs, he underwent tracheostomy tube placement, and on day 13 of his hospitalization, surgical placement of a diaphragmatic pacemaker. Upon admission to rehabilitation, he required continuous diaphragmatic pacing for respiratory support. During his stay, he underwent intensive cardiopulmonary rehabilitation, focused on pulmonary strengthening, which ultimately allowed for gradual weaning off of his diaphragmatic pacemaker.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: At discharge, he was tolerating continuous independent ventilation, although continued intermittent pacing as part of his pulmonary home exercise program . His respiratory function had significantly improved, as evidenced by an increase in maximum expiratory pressure from 12 to 30 cm H20, and maximum inspiratory pressure from 5 to 35 cm H2O. At his last follow up with his surgical team, he was considered a candidate for permanent discontinuation of his diaphragmatic pacemaker and pacemaker wire clipping.

Discussion (relevance): Respiratory failure is a significant complication of high cervical spinal cord injuries. Traditionally, diaphragmatic pacing has been used to transition patients with chronic ventilator-dependence , defined as greater than 1 year, off of mechanical ventilation. . In this case report, we highlight the utility of diaphragmatic pacing to successfully transition off of mechanical ventilation in the acute, post-injury phase of spinal cord injury. Further, this report highlights its role in improving pulmonary outcomes, and aiding in transition to independent respiration.

Conclusions: Cervical spinal cord injury patients with respiratory failure may benefit from early transition to diaphragmatic pacing to both enable weaning from mechanical ventilation and support respiratory muscle retraining to maximize respiratory independence.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/early-diaphragmatic-pacemaker-placement-in-a-patient-with-a-high-cervical-spinal-cord-injury-a-case-report/