Diaphragmatic Pacing

Diaphragmatic pacing is a therapy that makes it possible for certain paralyzed individuals to breathe without a respirator and regain the ability to speak.

Some patients with paralysis have been injured in such a way that they are unable to breathe without a respirator. For many years, respiration has provided a solution, but it requires a tracheostomy and the presence of cumbersome equipment, and most notably, patients on a respirator are not able to speak.

There is another solution available to some patients: diaphragmatic pacing. This therapy, also called phrenic nerve pacing, entails implantation of a small device that stimulates the diaphragm to move and expand the lungs. It is available for certain patients who are unable to breathe without mechanical assistance, including quadriplegics with spinal cord injuries to the C1 or C2 vertebrae, and some with respiratory disorders such as Ondine’s curse (Congenital Central Hypoventilation Syndrome, or CCHS), in which the brain stem does not detect elevated levels of CO2 in the blood.

If patients have nerve injury or spinal cord injury below the C2 vertebra, diaphragmatic pacing is not possible. But when pacing is possible, this therapy significantly improves their quality of life by eliminating the need for mechanical assistance. It is implanted through a very safe, minimally invasive procedure. After implantation, patients can speak, and they no longer have to rely on bulky breathing equipment, which is a significant burden in addition to their wheelchairs. Moreover, many can have their tracheostomies closed, which improves their overall safety.

Under the direction of Mark Ginsburg, MD, Associate Director, Thoracic Surgery Section, NYP/Columbia has offered diaphragmatic pacing to adults and children for 20 years, and is one of the world’s highest volume centers for this therapy.