Electrophrenic ventilation: a different perspective.

Since 1972, radio-frequency electrophrenic nerve pacing (EPP) has been an option for assisting the ventilation of patients with chronic paralytic respiratory insufficiency. Most of the medical literature has been favorable regarding its continued application. We reviewed the literature to determine how "successful" application of EPP was defined. Our studies indicated that long-term follow-up of EPP patients has been generally inadequate with little emphasis placed on incidence and severity of complications. There was no standardization in defining successful experiences with EPP. Upper airway instability during pacing, lack of internal pacemaker alarms, and the risk of sudden pacemaker failure necessitate permanent tracheostomy in the great majority of patients but complications of the presence of a tracheostomy were not considered in evaluating the desirability of EPP. Some EPP patients became independent of any ventilatory support thus benefiting minimally from the time commitment, effort, and extreme expense needed for EPP placement and training. We conclude that EPP is a valid option for the properly screened patient but that expense, failure rate, morbidity and mortality remain excessive and that alternative methods of ventilatory support should be explored.