From the Guidelines
A tracheostomy can cause bradycardia, as it may lead to hypoxia and cardiorespiratory deterioration, which can manifest as bradycardia, among other symptoms such as cyanosis, low oxygen saturations, and clinical signs of respiratory distress or obstruction 1.
Causes of Bradycardia in Tracheostomy
- Hypoxia: A blocked or displaced tracheostomy tube can cause hypoxia, leading to bradycardia and other cardiorespiratory complications 1.
- Respiratory distress: Tracheostomy-related complications, such as blockage or displacement of the tracheostomy tube, can cause respiratory distress, which may manifest as bradycardia 1.
Management of Bradycardia in Tracheostomy
- Oxygen therapy: Applying oxygen to the tracheostomy site or mouth/nose can help alleviate hypoxia and prevent bradycardia 1.
- Rescue breaths: Delivering rescue breaths via a facemask or tracheostomy tube can help restore adequate ventilation and prevent bradycardia 1.
- Cardiopulmonary resuscitation: In cases of severe bradycardia or cardiorespiratory arrest, cardiopulmonary resuscitation should be performed according to Advanced Paediatric Life Support guidelines 1.
From the Research
Tracheostomy and Bradycardia
- A tracheostomy, also known as a tracheal ostomy, can cause bradycardia (abnormally slow heart rate) in certain patients, particularly those with high cervical spinal cord transections who are in spinal shock and unable to breathe spontaneously 2.
- The bradycardia appears to be due to a vago-vagal reflex, which can be triggered by airway receptor stimulation, hypoxia, and the inability to breathe spontaneously 2.
- In patients with tetraplegia, tracheal suction can induce bradycardia and even cardiac arrest, especially when they are hypoxic 2.
- Atropine can be used to prevent bradycardia in response to tracheal suction, but it may not always be effective and can even accelerate the occurrence of cardiac arrest in some cases 3.
- Prolonged bradycardia can be a complication of tracheostomy in patients with high spinal cord injury, and is often associated with pneumonia, hypotension, and cardiac asystole 4.
Risk Factors for Bradycardia
- Hypotension on admission, pneumonia, and tracheostomy are risk factors for the development of prolonged bradycardia in patients with high spinal cord injury 4.
- Endotracheal suctioning and positioning of patients with high spinal cord injury can provoke prolonged bradycardia 4.
- Prematurity, genetic abnormalities, and preoperative mechanical ventilation are common in patients who undergo tracheostomy after operations for congenital heart disease, and may contribute to the risk of bradycardia 5.
Management of Bradycardia
- Atropine can be used to treat hypoxic bradycardia, but its effectiveness and potential risks must be carefully considered 2, 3.
- Adequate oxygenation and ventilation are crucial in preventing bradycardia in patients with tracheostomy 2.
- Conservative management, including careful monitoring and supportive care, may be sufficient for some patients with prolonged bradycardia 4.