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CompletedNCT01385384Updated Mar 19, 2013

Diaphragmatic Pacemaker in Tetraplegic Patients With Spinal Cord Injuries

An interventional study of NeuRx RA/4 diaphragmatic pacemaker in Respiratory Paralysis, Diaphragmatic Paralysis and Spinal Cord Injury, sponsored by University of Sao Paulo. Completed at 2 sites in Brazil. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2013-03-19.

Sponsored by University of Sao Paulo · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
5
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
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Study summary

Permanent dependency of breathing apparatus due to spinal cord injury is traditionally treated with different types of mechanical ventilation. However, the electric ventilation became a possibility through their most current versions, such as diaphragmatic pacemakers.

Diaphragmatic pacemakers rhythmically stimulates the diaphragm to replace the functions of the respiratory center that doesn't works well or is inaccessible. However, this modality has the prerequisite that the phrenic nerve and diaphragm muscle are normal. The reason for the development of diaphragmatic pacemaker freeing the patient from the ventilator.

By using the mechanical energy of the diaphragm of the patient, the patient may come not need the ventilator tubing, tracheostomy, and with the help of their caregivers, the inconvenient mechanical ventilators.

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Conditions studied

  • Respiratory Paralysis
  • Diaphragmatic Paralysis
  • Spinal Cord Injury
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In context

Respiratory Paralysis

37 studies on the registry are indexed under Respiratory Paralysis; 7 are open to participants now.

This study's enrollment of 5 is below the median of 48 across 19 interventional studies indexed under Respiratory Paralysis.

Browse Respiratory Paralysis studies →

Lead sponsor

University of Sao Paulo is the lead sponsor of 1,005 studies on the registry; 90 are open to participants now.

Of its 7 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • 18 years old or more
  • Cervical spinal cord injuries patients under mechanical ventilation
  • Clinically stable after spinal cord injury
  • Clinical acceptable bilateral phrenic nerve function demonstrated with electromyography and neural conduction time
  • Fluoroscopic visible diaphragmatic movements under stimulation
  • Hemodynamically stable
  • No co-morbidities that can interfere with pacemaker implantation or function
  • Pregnancy negative test for women
  • Patient or legal representative informed consent

Exclusion criteria

Exclusion Criteria:

  • Active pulmonary disease
  • Active cardiovascular disease
  • Active cerebral disease
  • Hemodynamic instability or low oxygen levels in ambient air
  • Hospitalization for infection in the last 3 months
  • Significant scoliosis or chest disease
  • Obesity
  • Poor compliance to the protocol from the patient or the caregiver
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Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Non-randomized
Intervention model
Single group
Masking
None (open label)
Enrollment
5 participants (actual)

Study arms

  • Other
    NeuRx

    Device: NeuRx RA/4 diaphragmatic pacemaker

Interventions

  • DeviceNeuRx RA/4 diaphragmatic pacemaker

    Patients will be implanted with 4 intramuscular electrodes, 2 in each hemi-diaphragm, using laparoscopic techniques. The abdominal cavity is inflated with CO2 and 4 ports are inserted: one for optics, 2 for a probe containing a temporary electrode for mapping the diaphragm and the electrode insertion tool, and a smaller one for the output wires of the electrodes of the abdominal cavity. The intra-abdominal pressure variation during the stimulation test (mapping) will be measured externally by one of the ports. Sites that provide the optimal response (greater region and magnitude) are noted. Once the optimal site for electrode placement is identified two intramuscular electrodes are deployed in each hemi-diaphragm. The guide wires will come out of the peritoneum through the port placed in the xiphoid region. An additional electrode is placed subcutaneously in the upper abdomen. The instruments and ports are then removed and the incision sites closed.

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What researchers measure

Primary outcomes

  1. Volume comparison of the basal with the tidal volume obtained with the NeuRx RA/4 pacemaker in patients with diaphragmatic paralysis

    The ability of the NeuRx RA / 4 to obtain clinically acceptable tidal volume during a period of 4 continuous hours will be evaluated by spirometry. Clinically acceptable volume is defined as a volume in excess of 15% above the basal metabolic requirements of the particular patient. For a male patient, the flow volume to meet the basal metabolic requirement is set at 7 ml/kg body weight, while for a female patient, it is defined in 6ml/Kg body weight.

    Time frame: One year

Secondary outcomes

  1. Functional rehabilitation by measure of total usage time, both day and night

    Using spreadsheets to patients and caregivers, will collect information related to the use of the device, such as total usage time, the preference to use it both day and night instead of a mechanical ventilator, or to use it partial time to perform any activity or acquire independence that would otherwise be difficult with mechanical ventilation.

    Time frame: One year

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Study locations

2 sites
  • Heart Institute (InCor) Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
    Sao Paulo, SP, Brazil
  • Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
    Sao Paulo, Brazil
08

References and documents

Publications

  • Tedde ML, Vasconcelos Filho P, Hajjar LA, de Almeida JP, Flora GF, Okumura EM, Osawa EA, Fukushima JT, Teixeira MJ, Galas FR, Jatene FB, Auler JO Jr. Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management. Clinics (Sao Paulo). 2012 Nov;67(11):1265-9. doi: 10.6061/clinics/2012(11)07. PubMed 23184201 ↗
  • Tedde ML, Onders RP, Teixeira MJ, Lage SG, Ballester G, Brotto MW, Okumura EM, Jatene FB. Electric ventilation: indications for and technical aspects of diaphragm pacing stimulation surgical implantation. J Bras Pneumol. 2012 Sep-Oct;38(5):566-72. doi: 10.1590/s1806-37132012000500005. English, Portuguese. PubMed 23147048 ↗
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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Mar 19, 2013, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT01385384
Lead sponsor
University of Sao Paulo
Collaborators
Synapse Biomedical
Responsible party
Miguel L. Tedde (MD, PhD, University of Sao Paulo) — Principal investigator
First posted
Jun 30, 2011
Start date
Jun 2011
Primary completion
Nov 2012
Completion
Dec 2012
Last update
Mar 19, 2013

Study contacts

Fabio B Jatene, MD, PhD
study director · Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
Manuel J Teixeira, MD, PhD
study chair · Neurosurgery Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo
Miguel L Tedde, MD, PhD
principal investigator · Thoracic Surgery Department, Heart Institute (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Mar 2013. You cannot join it, but the record below documents what was studied.

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