From the Research
The minimum systolic ejection fraction (EF) recommended for an epidural steroid injection is typically 30%. Patients with an ejection fraction below 30% are generally considered high-risk for invasive procedures due to their compromised cardiac function. When performing epidural steroid injections in patients with heart failure, careful consideration should be given to the patient's overall cardiovascular status, including recent symptoms, exercise tolerance, and medication regimen. The procedure should be performed in a setting where appropriate monitoring is available, including continuous pulse oximetry, blood pressure monitoring, and access to emergency medications and equipment.
The concern with lower ejection fractions is that these patients have reduced cardiac reserve and may not tolerate the physiological stress of the procedure, including potential vasovagal responses, medication side effects, or complications. Additionally, patients with severe heart failure may have difficulty lying flat for the procedure. For patients with borderline ejection fractions (30-40%), consider cardiology consultation prior to the procedure to optimize cardiac status and medication management. Although the provided evidence does not directly address the minimum systolic ejection fraction for epidural steroid injections, the recommendation is based on general principles of managing patients with heart failure and invasive procedures 1, 2, 3, 4, 5.
Some key points to consider when performing epidural steroid injections include:
- Careful patient selection and evaluation of cardiovascular status
- Appropriate monitoring and emergency equipment availability
- Consideration of cardiology consultation for borderline ejection fractions
- Optimization of cardiac status and medication management before the procedure
- Potential risks and benefits of the procedure, including effects on bone mineral density and vertebral fracture risk 5.
It is essential to weigh the potential benefits of epidural steroid injections against the potential risks, particularly in patients with compromised cardiac function. By carefully evaluating each patient's individual circumstances and taking necessary precautions, healthcare providers can minimize risks and optimize outcomes for patients undergoing epidural steroid injections.