Diaphragmatic pacemaker

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A respiratory pacemaker or diaphragmatic pacemaker is an implant that provides electrical stimulation of the diaphragm via the phrenic nerve to ventilate people with paraplegia who are paralyzed from the neck down. The term "respiratory pacemaker" is an analogy to the better known cardiac pacemaker .

Application area

Tetraplegics with high transverse injuries (above C3 - see segmental innervation , segments of the spine ) must be ventilated because the stimulation (innervation) of the diaphragm via the two phrenic nerves no longer works. In the past, this ventilation was done with the help of the so-called iron lung - today with ventilators via a tracheostoma . The functional electrical stimulation offers an alternative by the still intact diaphragm including the associated motor nerves ( phrenic nerve ) is reactivated for breathing. An implanted electrostimulator stimulates the phrenic nerve (s) with small electrodes sewn on there. The diaphragm contracts , creating negative pressure in the lungs .

As reported by the German Medical Journal, Charité surgeons implanted such a pacemaker in December 2007 in two German patients with ALS as part of an ongoing study. After a study with 50 people with paraplegia demonstrated that they could effectively be released from the ventilator for several hours, the US government agency FDA approved a further diaphragmatic pacemaker in June 2008.

Breathing pacemakers are rarely used, although the technical requirements are met. The main reason for this is the high cost of manufacturing, implanting and maintaining such systems.

literature

  • RP Onders, MJ Elmo, AR Ignagni: Diaphragm pacing stimulation system for tetraplegia in individuals injured during childhood or adolescence. In: J Spinal Cord Med. 30 Suppl 1, 2007, pp. S25-S29. PMID 17874683
  • MB Zimmer, K. Nantwi, HG Goshgarian: Effect of spinal cord injury on the respiratory system: basic research and current clinical treatment options. In: J Spinal Cord Med. 30 (4), 2007, pp. 319-330. PMID 17853653

Web links

Individual evidence

  1. ↑ FDA press release of June 18, 2008: FDA Approves Diaphragm-Pacing Device