Long-term experience with diaphragm pacing for traumatic spinal cord injury: Early implantation should be considered

Onders, Raymond P.; Elmo, MaryJo; Kaplan, Cindy; Schilz, Robert; Katirji, Bashar; Tinkoff, Glen

doi:10.1016/j.surg.2018.06.050

Cited by 35 publications

(42 citation statements)

References 17 publications

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“…The 4-h time frame was selected based on the user being able to participate in community-based activities such as attending church services, going to a movie, and dining out without the onerous burdens associated with MV. We showed that 73 and 77% of patients achieved this threshold at 6 and 12 months of follow-up, which is similar to the experience reported by others that 88 and 86% of patients used the device for at least this length of time [4, 8]. Further, we demonstrated complete liberation from MV in 36% of patients, which is within the range of 25–73% reported in other studies [4, 8-11].…”

Section: Discussion/conclusionsupporting

confidence: 90%

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Wijkstra

Hofker

et al. 2021

Respiration

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Background: Patients with high spinal cord injury (SCI) are unable to breathe on their own and require mechanical ventilation (MV). The long-term use of MV is associated with increased morbidity and mortality. In patients with intact phrenic nerve function, patients can be partially or completely removed from MV by directly stimulating the diaphragm motor points with a diaphragm pacing system (DPS). Objectives: We describe our multicenter European experience using DPS in SCI patients who required MV. Methods: We conducted a retrospective study of patients who were evaluated for the implantation of DPS. Patients evaluated for DPS who met the prospectively defined criteria of being at least 1 year of age, and having cervical injury resulting in a complete or partial dependency on MV were included. Patients who received DPS implants were followed for up to 1 year for device usage and safety. Results: Across 3 centers, 47 patients with high SCI were evaluated for DPS, and 34 were implanted. Twenty-one patients had 12 months of follow-up data with a median DPS use of 15 h/day (interquartile range 4, 24). Eight patients (38.1%) achieved complete MV weaning using DPS 24 h/day. Two DPS-related complications were surgical device revision and a wire eruption. No other major complications were associated with DPS use. Conclusions: Diaphragm pacing represents an attractive alternative stand-alone treatment or adjunctive therapy compared to MV in patients with high SCI. After a period of acclimation, the patients were able to reduce the daily use of MV, and many could be completely removed from MV.

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Section: Discussion/conclusionsupporting

confidence: 90%

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Wijkstra

Hofker

et al. 2021

Respiration

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“…Leitliniengemäß ist die NIV indiziert, wenn Symptome einer SBAS vorliegen, eine signifikante Atemmuskelschwäche (VK < 50 % des Sollwertes, MIP < 60 cm H 2 O) festgestellt wird und eine Hyperkapnie am Tag oder in der Nacht nachgewiesen werden kann [19]. Für Patienten mit hohem Querschnitt stellt neben der nicht invasiven oder invasiven Heimbeatmung die möglichst frühzeitige elektrische Phrenicus-oder Zwerchfellstimulation eine Behandlungsmöglichkeit dar [80]. Ein entsprechender Therapieansatz bei Patienten mit ALS und respiratorischer Insuffizienz hat sich als nicht effektiv erwiesen [81,82].…”

Section: Sbas Bei Neuromuskulären Und Spinalen Erkrankungenunclassified

Schlafbezogene Atmungsstörungen

Boentert¹

2021

Nervenheilkunde

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ZUSAMMENFASSUNGSchlafbezogene Atmungsstörungen (SBAS) haben einen hohen bevölkerungsmedizinischen Stellenwert. Sie sind nicht nur mit bekannten Risikofaktoren wie Alter oder Adipositas assoziiert, sondern treten häufig auch im Rahmen neurologischer Erkrankungen auf und spielen eine große Rolle für die Krankheitslast und Prognose betroffener Menschen. Dieser Artikel skizziert die Pathophysiologie der verschiedenen SBAS und ihren spezifischen Stellenwert bei wichtigen neurologischen Krankheitsbildern. Ferner werden die für Neurologen relevanten Grundprinzipien von Diagnostik und Therapie dargestellt.

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“…Percutaneous leads have been used for diaphragm pacing for decades as a life-saving procedure, thus justifying the above-mentioned risks. Controversially, for prosthetic control the risk-benefit-ratio may not be as favorable, since the available 1-2 channels are insufficient (Onders et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Experimental Testing of Bionic Peripheral Nerve and Muscle Interfaces: Animal Model Considerations

et al. 2020

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Introduction: Man-machine interfacing remains the main challenge for accurate and reliable control of bionic prostheses. Implantable electrodes in nerves and muscles may overcome some of the limitations by significantly increasing the interface's reliability and bandwidth. Before human application, experimental preclinical testing is essential to assess chronic in-vivo biocompatibility and functionality. Here, we analyze available animal models, their costs and ethical challenges in special regards to simulating a potentially life-long application in a short period of time and in non-biped animals. Methods:We performed a literature analysis following the PRISMA guidelines including all animal models used to record neural or muscular activity via implantable electrodes, evaluating animal models, group size, duration, origin of publication as well as type of interface. Furthermore, behavioral, ethical, and economic considerations of these models were analyzed. Additionally, we discuss experience and surgical approaches with rat, sheep, and primate models and an approach for international standardized testing. Results:Overall, 343 studies matched the search terms, dominantly originating from the US (55%) and Europe (34%), using mainly small animal models (rat: 40%). Electrode placement was dominantly neural (77%) compared to muscular (23%). Large animal models had a mean duration of 135 ± 87.2 days, with a mean of 5.3 ± 3.4 animals per trial. Small animal models had a mean duration of 85 ± 11.2 days, with a mean of 12.4 ± 1.7 animals.Discussion: Only 37% animal models were by definition chronic tests (>3 months) and thus potentially provide information on long-term performance. Costs for large animals were up to 45 times higher than small animals. However, costs are relatively small compared to complication costs in human long-term applications. Overall, we believe a combination of small animals for preliminary primary electrode testing and large animals to investigate long-term biocompatibility, impedance, and tissue regeneration parameters provides sufficient data to ensure long-term human applications.

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Long-term experience with diaphragm pacing for traumatic spinal cord injury: Early implantation should be considered

Cited by 35 publications

References 17 publications

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience

Schlafbezogene Atmungsstörungen

Experimental Testing of Bionic Peripheral Nerve and Muscle Interfaces: Animal Model Considerations

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