Prolonged Bradycardia, Asystole and Outcome of High Spinal Cord Injury Patients

Abstract

ABSTRACT High spinal cord injury (HSCI) is one of the devastating traumatic injuries. Majority of these patients are young male and 93% will have major neurological disabilities. The aim of this study was to know the prevalence, risk and precipitating factors for prolonged bradycardia in the HSCI patients. Patients and methods All patients who were admitted to the intensive care unit (ICU) of 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; precipitating, risk factors and outcome were recorded. Results During the study period, total 138 patients were admitted to the intensive care unit with HSCI. Majority of patients were male. The most frequently associated injury was skeletal fractures (38.4%). Pneumonia in 56 (41%) was the most common complication. Forty-five (33%) patients had prolonged bradycardia; 53.4% had cardiac asystole, 29 (21%) patients had bradycardia during endotracheal suctioning, where, as 27 (20%) patients developed bradycardia at positioning. HSCI patients with prolonged bradycardia had significantly higher, ISS score, ICU and hospitals stay. Multivariate analysis revealed that hypotension on admission; pneumonia and tracheostomy were risk factors for the development of prolonged bradycardia. Conclusion Prolonged bradycardia was associated with significantly higher incidence of asystole. Endotracheal suctioning and positioning of HSCI patients were provocative factors for prolonged bradycardia. Hypotension on admission, pneumonia and tracheostomy were the risk factors for development of prolonged bradycardia. How to cite this article Shaikh N, Raza A, Rahman A, Shabana A, Malstrome F, Al-Sulaiti G. Prolonged Bradycardia, Asystole and Outcome of High Spinal Cord Injury Patients. Panam J Trauma Crit Care Emerg Surg 2014;3(3):87-92.