As published in the Journal of Clinical Neuroscience, physicians at the Prince of Wales Hospital provide a retrospective analysis of the patients implanted with diaphragm pacing in Australia.

"Phrenic nerve stimulation is a technique whereby a nerve stimulator provides electrical stimulation of the phrenic nerve to cause diaphragmatic contraction. The most common indications for this procedure are central alveolar hypoventilation and high quadriplegia."

"We reviewed the available data on patients who have had phrenic nerve stimulators implanted in Australia. These data were obtained from Avery Biomedical Devices, who have been, and are currently, the sole distributor of this device to Australia. The available medical records were then obtained from the relevant hospitals and any additional useful information was retrieved from these, including infections, failure of device, lead migration and longevity of stimulation."

"Phrenic nerve stimulators can be implanted via two routes – a cervical approach, or a thoracic approach. Initially, the thoracic approach involved a thoracotomy, but more recently a less-invasive thorascopic approach has been used successfully. Intramuscular diaphragm stimulation is another technique described that aims to cause less potential injury to the phrenic nerve through direct stimulation of the diaphragm – however, electrode wires that exit the skin carry a small but significant infection risk."

"Of the patients known to be actively pacing, the average duration of ongoing pacing is 13 years – this suggests that phrenic nerve stimulators can be used in the long term instead of mechanical ventilators for ongoing respiratory support."

Khong P, Lazzaro A, Mobbs R. "Phrenic Nerve Stimulation: The Australian Experience" J Clin Neurosci. 2010; Vol. 17, No. 2, pp. 205-208.