1143 - Miraculous Recovery of Prolonged Cardiac Arrest Induced Ischemic Spinal Cord Injury (SCI) Enhanced with Exoskeleton Use

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SP

Sung-Hoon Park, n/a

Medical Student
McGovern Medical School - Houston, TX
League City, Texas, United States

Co-Author(s)

SD

Stacey L. DO, DO

Associate Professor and Medical Director
UTHealth-Houston/TIRR Memorial Hermann
Houston, Texas, United States
SJ

Simra Javaid, DO

Assistant Professor
TIRR Memorial Hermann
Houston, Texas, United States

Case Diagnosis: A 16-year-old boy sustained acute ischemic SCI (T5 ASIA C) secondary to cardiac arrest. Patient has a RYR2 variant genetic mutation associated with catecholaminergic polymorphic ventricular tachycardia (CPVT).

Case Description: Patient had a cardiac arrest while rock-climbing. CPR was performed for two hours. Patient was pronounced dead until miraculously awakening 5 minutes later. The patient was diagnosed with T5 ASIA C SCI and received a two-month inpatient rehabilitation.
On admission, patient required moderate-total assistance for ADLs. During inpatient rehabilitation, patient received intensive PT/OT/SLP, which was enhanced with twice weekly exoskeleton use. By discharge, he was modified independent with ADLs and supervision for ambulation using a rolling walker, bilateral AFOs, and a right hinged knee brace.

Discussions: CPVT is a rare inherited condition that, if untreated, can be highly lethal. It is estimated that ~30% experience at least one cardiac arrest, often the first manifestation of the disease. Comprehensive meta-analysis revealed that the out-of-hospital cardiac arrest survival rate is 7.6%, rising to 10% with bystander CPR. Many survivors sustain ischemic SCI. To enhance recovery in such cases, rehabilitation sessions have been proven effective, as in the case of this patient. Recent research has demonstrated that the use of exoskeletons significantly improves functional recovery in patients with SCI. However, it should be noted that exoskeleton technology is still relatively new and its availability, particularly for the pediatric population, is quite limited. Most require a minimum height of ~5', with the smallest allowing for 4'7". Fortunately, this patient was treated at a facility with various exoskeleton options and was just tall enough to fit into one of the suits.

Conclusions: This case emphasizes the importance of developing and having a pediatric exoskeleton available in all major rehabilitation facilities to ensure patients are able to have the best prognosis.