A wild idea - phrenic nerve "pacemakers" for sedative OD?

[sekio]

The other day I came up with an idea. Cardiac pacemakers are a thing, and my preliminary reading suggests that phrenic nerve stimulation is a thing too, used in cases of severe sleep apnea.

How about an implantable device that acts as a pacemaker for the diaphragm (via the phrenic nerve) when it senses it would be appropriate? (Either by passively sensing the normal electrical activity and activating when it detects inactivity, or with some means of sensing SpO2). The idea would be, people at risk for opioid/sedative overdoses could get one implanted, which would effectively act as a "backup brainstem" and keep the person breathing for long enough to either regain conciousness, get ventilator support, or for an antidote to be administered. In fact, maybe the device could act like an internally implanted Narcan kit, and deliver an IP infusion of naloxone.

I think the only case a device like this would be of no use would be in the case of aspiration or asphyxia. Of course if the airway is blocked, all the diaphragm stimulation in the world won't help.

A benefit of the device would be its ability to counteract sedative overdose no matter the causative agent. If breathing is depressed, the device will kick in, no matter if it's a GABAergic, opioid, combination of the two, or something else. The only thing it wouldn't protect against would be paralytic agents, but thankfully nobody cuts dope with curare or succinylcholine. (I hope!)

(Sidebar: Do people use nikethamide any more? Does it actually function as a respiratory stimulant? It's WADA banned so I assume it must have some activity. Is it of any use in opiate overdose?)

Maybe in some dystopian future they would mandate implanting such a device in individuals who end up in the hospital after ODing too often. Or maybe it could be of use in narcotic therapy for pain/palliative care, allowing more liberal use of opioid therapy by lessening the risk of OD.

What do y'all think? Am I full of it, or is this potentially something that could see usage somewhere in the future?

 

[Gaffy]

Sounds good, but what do you do the day tbat you fall from your surfboard under a big wave, get rolled underwater and have to keep yourself from breathing, then that breathpacemaker notices SpO2 shortage..
Otherwise it's a fantastic idea!

 

[polymath]

I think the only case a device like this would be of no use would be in the case of aspiration or asphyxia. Of course if the airway is blocked, all the diaphragm stimulation in the world won't help.

Then just add a permanent tracheotomy intubation and a speech generator that reads your brain waves and allows you to speak with your mind.

 

[Gaffy]

Like Bezos in southpark

 

[sekio]

but what do you do the day tbat you fall from your surfboard under a big wave, get rolled underwater and have to keep yourself from breathing, then that breathpacemaker notices SpO2 shortage..

Something suggests to me that if you were so medicated with opioids that you'd need to rely on support for your breathing, surfboarding is probably low on the list of things you'd do for recreational activities. Or maybe I'm wrong and surfing while nodding out is a magical experience? I think it sounds kinda hazardous, actually.

Then just add a permanent tracheotomy intubation and a speech generator that reads your brain waves and allows you to speak with your mind.

How about a replacable CO2 scrubber installed in the windpipe? I'm sure sticking a few hundred grams of potassium superoxide into my gullet is perfectly safe.