Cardiac asystole following high spinal cord injury: a case report

Cardiac asystole following cervical spine injury is rare and occurs after approximately 15-16% of cases of high spinal cord injury. While incidence of cardiac abnormalities after high spinal cord injury typically peak at 4-7 days following the initial injury, they have been reported to take up to 2-6 weeks to resolve. In our case the patient was found unresponsive in the field with pulseless cardiac activity. She had return of spontaneous circulation after a short period of cardiopulmonary resuscitation (CPR) and was transferred to the trauma intensive care unit (ICU) where she developed progressive motor and sensory deficits and was found to have anterior subluxation of C2 and C3 as well as fractures of the C2 and C3 vertebrae that were treated with decompression and C1-5 fusion. She has done well post-operatively and has had no further cardiac abnormalities since the time of her initial injury. The authors believe that patients that experience cardiac asystole secondary to high spinal cord injury who have rapid recovery of cardiac function can be managed with appropriate monitoring without medical management with inotropic agents or cardiac pacemaker implantation, and surgery to address neurologic deficits should not be delayed.