#3 Diaphragm Pacing System

Overview

On a warm summer day in Chicago in 2002, Laszlo Nagy, 36, was riding his motorcycle when his passenger suddenly reached over and twisted the throttle to make the bike go faster—right into the path of an oncoming car. Nagy hurtled through the windshield, broke his neck, and was initially listed as dead on the scene. Revived and raced to a trauma center, the stockbroker spent the next several months in the hospital and rehabilitation center connected to a mechanical ventilator. Unable to move his four limbs but able to shrug his shoulders, he began to learn how to live as a C-3 tetraplegic.

It certainly wasn’t easy, especially because of the ventilator. “I cried myself to sleep every night,” says Mr. Nagy of the noisy ventilator that connected with tubing through a hole in his neck, and allowed his lungs to fill with oxygen. “Once I got my power wheelchair, the 100-pound ventilator was placed on a tray on the back, with the battery down below.” Nagy had mobility but not without significant anxiety. “If one of the many hoses got disconnected, I had to be near someone who knew how to put it back in. And if my battery ran out, I would be at great risk,” he says. “It was a very challenging lifestyle.”

Mr. Nagy’s life took a dramatic turn for the better in June 2005 when he had an experimental diaphragm pacing system implanted that would replace his bulky ventilator. Laparoscopic surgery was performed by Anthony F. DiMarco, M.D., who developed the novel device along with his Case Western Reserve University colleague, Raymond Onders, M.D. Four electrodes were connected to the phrenic nerves on Nagy’s diaphragm, the dome-shaped muscle below the ribs that causes air to flow to the lungs. Wires from the electrodes run to and from a control box about the size of two decks of playing cards worn outside the body. When the electrodes are stimulated by current, the diaphragm contracts and air is sucked into the lungs. When not stimulated, the diaphragm relaxes and air moves out of the lungs.

Two weeks after the surgery, Mr. Nagy was gradually weaned off his ventilator and learned to breathe with his new pacing system. “It didn’t take long before I could get reasonable, sustainable, and comfortable breaths,” he says.

Mr. Nagy never could have imagined how his life was going to change because of the pacing system. “I now own my own home. I got married and my wife and I have traveled all over the country. We are now expecting a baby in April.”

Where Are They Now

In 2015 the diaphragm pacing device was reposted as possibly being more harmful than helpful in patients with amyotrophic lateral sclerosis (ALS). Several clinical trials kicked off in 2016 for continued evaluation of the safety and efficacy of these devices.

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