Mario Zapata

Mario Zapata, St. Joseph's patient.The bullet that tore through Mario Zapata’s flesh lodged high in his cervical spinal cord and left him immediately paralyzed from the neck down. The metal fragments damaged his C3, C4 and C5 cervical vertebrae – the ones responsible for controlling the diaphragm and allowing the body to breathe on its own. He was placed on a ventilator, and for three years, that was how his body breathed.

“There are so many feelings that go along with an injury like this,” Mario, 28, says. “I’ve thought a lot about how my life has changed. I used to get upset thinking about all the things I’ve lost, and I’d get discouraged because I can’t even breathe on my own.”

And then one day Mario was surfing the internet. “For some reason I was watching a YouTube video on cardiac pacemakers, and the next video that popped up was a pacemaker for the diaphragm,” he says. The diaphragmatic pacing system by Synapse Biomedical was approved by the FDA in 2008 for ventilator- dependent spinal cord injury patients who lack voluntary control of their diaphragm.

“Every time I had an appointment with my pulmonologist, I would ask him if I’d ever breathe on my own again. He told me there was a very low possibility, and I had already accepted that answer, but my mom never did. She kept wanting me to ask.”

So on his next visit, Mario asked the question again. And this time pulmonologist Gregory Ahearn, MD, brought cardiothoracic surgeon Elbert Kuo, MD, MPH, MMS, into the room.

“Dr. Kuo asked me if I had ever heard of diaphragmatic pacing. I told him about what I found on YouTube, and together, the doctors said I seemed like the perfect candidate for it. They took some x-rays and told me they’d get back with me in a couple of days. I was scheduled for surgery on April 23.”

Mario’s device was the first implanted in Arizona. During the minimally invasive surgery, the surgeon creates four small holes in the abdomen and places small electrodes near the nerves that control the diaphragm. The electrodes are then attached through wires under the skin to a small battery-powered external pulse generator that stimulates the muscle and nerves to make the diaphragm contract.

“It’s almost like doing pushups,” says Dr. Kuo. “There is an electrical signal sent from your brain to the muscle that tells your arm to contract. In this case, the device sends the electrical signal that tells the diaphragm to contract. That causes the lungs to expand, and that allows Mario to breathe.”

“I remember waking up after the surgery asking my nurse if it had worked. She told me yes but that it wasn’t turned on yet. And then I went back to sleep. When I woke up again, my room was full of doctors, and there were wires connected to me. They hooked everything up, and I was breathing on my own for an hour and a half.”

The diaphragm, like all muscles, atrophies without use. So the device must be used in short spurts at first in order to rebuild strength in the muscle. The small device gives him more freedom to maneuver outside of the home without a bulky ventilator and the plethora of tubes that attach it to him. It also brought back Mario’s sense of smell because he’s able to breathe through his nose – something that wasn’t possible with the ventilator.

And according to Dr. Kuo, there are additional benefits besides the one’s Mario has experienced. The diaphragmatic pacemaker can save more than $3 million in healthcare costs over the lifetime of a 25-year-old patient. Patients using the device also see a decrease in pneumonia and have an easier time talking.

“The future holds happiness for me and my family. It’s a big change in my life. It’s a big deal. I’m so happy for it.”