Abstract Details

Title Selection Criteria of Diaphragm Pacemaker Implantation in ALS Patients

Topic Anterior Horn

Presentation(s) P07 - (-)

Poster/Presentation
Number 084

Objective

Background BACKGROUND: Diaphragm Pacing is a newly FDA approved method for management of respiratory failure in amyotrophic lateral sclerosis patients. Currently there are three main criteria used for evaluation prior to implantation, pulmonary function testing, radiographic SNIFF testing, and diaphragm motor response to phrenic nerve stimulation. These are used to determine if a patient is an ideal candidate for the pacemaker. The final determination, however, is made in the operating room by direct stimulation of the diaphragm. Patients must be intubated for this procedure. Activating the newly inserted pacemaker makes extubation far less difficult. It is critical to minimize the possibility that the patients are found to have an electrically inexcitable diaphragm in the operating room, thus resulting in aborting the procedure.

Design/Methods DESIGN/METHODS: Our center has performed 19 diaphragm pacemaker placements to date. We looked at each patients pre-operative test results and compared those numbers to what we measured intra-operatively with direct diaphragm stimulation. We also looked at the patients overall clinical picture after placement of the device to come to our overall conclusions.

Results RESULTS: We performed a retrospective review of our patients and found that individually the above test do not necessarily correlate well with diaphragm excitability in the OR. However, in combination, and in association with the clinical picture of the patient, there is a far better correlation.

Conclusions CONCLUSIONS: The key seems to be associating the above criteria along with the patients overall clinical picture in order to come to a better decision when choosing acceptable candidates.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
Evgeny Tsimerinov, MD, PhD, FAAN (Neurology, Inc)	No disclosure on file
Abirami Muthukumaran, MD (Ventura County Medical System)	Dr. Muthukumaran has nothing to disclose.
Robert H. Baloh, MD, PhD, FAAN (Novartis Institutes for BioMedical Research)	Dr. Baloh has received personal compensation for serving as an employee of Roche. Dr. Baloh has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Acurastem. Dr. Baloh has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Irell. The institution of Dr. Baloh has received research support from NIH and CIRM.

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