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Early Utilization Of Diaphragm Pacing During The Covid-19 Pandemic For Cervical Spinal Cord Injured Patients To Decrease Mechanical Ventilation
Raymond Onders, *MaryJo Elmo, *Glen Tinkoff
University Hospitals Cleveland Medical Center, Cleveland, OH

OBJECTIVE(S): Decreasing the burden of mechanical ventilation (MV) for spinal cord injuries (SCI) was never more relevant than during the COVID 19 pandemic. Data has consistently shown diaphragm pacing (DP) can replace MV, decrease wean times, improve respiratory mechanics and decrease hospital costs for SCI patients. This is largest analysis of DP implants during the COVID-19 pandemic.
METHODS: This is a retrospective analysis of prospective IRB approved databases of non-randomized interventional experience at a single institution. Subgroup analysis was then limited to traumatic cervical SCI that were implanted laparoscopically with diaphragm electrodes within 30 days of injury.
RESULTS: The database included 197 patients with DP implantations from 1/2020 to 1/2022 for all indications. For the study group of early implanted traumatic cervical SCI, there were 13 (all male) patients with average age at implant 49.3 years (range 17-70). Injury mechanisms included falls (6), MVA (4), GSW (2) and diving (1). Time from injury to DP averaged 11 days (range 3-22). Two patients are deceased and neither weaned from MV ( one withdrew care 14 days post injury and one withdrew care after decubitus sepsis in rehabilitation center day 86 post injury). Nine of the remaining 11 patients weaned from MV. Four patients never had a tracheostomy and three additional patients had tracheostomy decannulation. The two who failed to wean had good stimulatable diaphragms at surgery but had significant difficulty with long term care facilities for weaning with no family support. Three of these high risk pulmonary compromised patients survived COVID 19 infections utilizing DP.
CONCLUSIONS: Early DP successfully weaned from MV 82% of patients surviving past 90 days. 44% of this group never underwent a tracheostomy. Only 22% of the weaned group of quadriplegics required tracheostomies for secretions. Obstacles to weaning with early DP were not related to DP: patient withdrawal of care and long term care issues. Decreased MV and tracheostomy use allowed earlier and easier placement for rehabilitation. Early DP for SCI once stabilized is a strategy to be employed to decrease MV usage especially when faced with critical needs of MV during future disasters or pandemics.


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