Cardiac arrest attributable to dysfunction of the autonomic nervous system after traumatic cervical spinal cord injury

Abstract

Bradycardia is the most common form of dysrhythmia developing after disruption of the sympathetic pathway by a spinal cord injury (SCI), and it can have fatal consequences, including cardiac arrest. Here, we report a case of cardiac arrest developing after cervical SCI attributable to sympathetic hypoactivity. A 26-year-old male pedestrian was admitted after a traffic accident. Radiologically, fractures were apparent at the C6–7 bilateral articular facets, and cord contusion with hemorrhage was evident at C4–7. During his stay in ICU, intermittent bradycardia was noted, but the symptoms were not specific. On the 22nd postoperative day, the patient was taken to the computed tomography suite for further evaluation and experienced cardiac arrest during a positional change. After immediate cardiac massage, the patient was resuscitated. We scheduled Holter monitoring, which detected 26 pauses, the longest of which was 17.9 s. The patient underwent cardiac pacemaker insertion. No further cardiac events were noted.

Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis

“…Several mechanisms have been proposed which may explain the increased risk of cardiac arrest among patients with concomitant OH and AF. Autonomic nervous system dysregulation is thought to be central in the pathogenesis of OH [39], AF [40], and cardiac arrest [41]. Additionally, autonomic nervous system dysregulation may lead to arterial stiffness [42], a common pathophysiological change attributed to hypertension and aging.…”

Incidence and risk factors of deep vein thrombosis in patients with spinal cord injury: a systematic review with meta-analysis

“…For example, complete SCI, especially SCI above T6, will seriously affect the sympathetic control of cardiac function, resulting in decreased myocardial contractility and dilatation of capillaries, gastrointestinal vascular beds and coronary arteries, resulting in a reduction of effective blood volume by about 50%. This not only increases the blood viscosity, but also greatly reduces the oxygen supply of muscle and the contractility of muscle, which eventually leads to the decrease of deep venous blood flow velocity of lower extremities and increases the incidence of DVT (39). In addition to the effects of the complications themselves, these complications also prolong the patient's bed rest and braking time.…”

Road bike accidents involving cervical fractures presenting as cardiac arrest: a report of two cases

“…Following CCI, bradycardia is the most common cardiac arrhythmia. Cardiac arrest following CCI has both been described immediately after CCI and in the days following CCI [9].…”