Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

Nissar Shaikh; M A Rhaman; Ali Raza; Adel Shabana; Mahommad Faisal Malstrom; Ghanem Al-Sulaiti

doi:10.4103/1793-5482.146394

Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

Asian J Neurosurg. 2016 Oct-Dec;11(4):427-432. doi: 10.4103/1793-5482.146394.

Authors

Nissar Shaikh¹, M A Rhaman¹, Ali Raza², Adel Shabana³, Mahommad Faisal Malstrom¹, Ghanem Al-Sulaiti²

Affiliations

¹ Department of Anesthesia/ICU, Hamad Medical Corporation, Weill Cornell Medical College in, Qatar.
² Department of Neurosurgery, Hamad Medical Corporation, Weill Cornell Medical College in, Qatar.
³ Department of Cardiology and Cardiothoracic Surgery, Hamad Medical Corporation, Weill Cornell Medical College in, Qatar.

Abstract

Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients.

Materials and methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded.

Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients.

Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were significant provocative factors for prolonged bradycardia; hypotension on admission, pneumonia and tracheostomy were the risk factors for the development of prolonged bradycardia in these patients.

Keywords: Asystole; atropine; autonomic nervous system; bradycardia; high spinal cord injury.