Cervical spinal cord injury patients are prone to developing hypotension and bradycardia, which can lead to cardiac arrest. However, there is no clear consensus regarding the indications for permanent pacemaker (PPM) implantation. Here, we present a case of cervical spinal cord injury that required PPM implantation after experiencing two episodes of cardiac arrest. The patient was a woman in her 40s with traumatic spinal cord injury below C6, that was classified as A on the Frankel scale, due to a traffic accident that resulted in the death of a passenger. She frequently experienced bradycardia with a heart rate of 40-50 beats per minute and suddenly went into cardiac arrest during oral care on the 3rd and 8th days of hospitalization. Since this was determined as being due to autonomic dysfunction associated with high-level spinal cord injury, a PPM was implanted on the 16th day of hospitalization following temporary pacemaker implantation. Subsequently, there were no further episodes of bradycardia or cardiac arrest, and her condition stabilized. She was transferred to another facility for rehabilitation on the 119th day of hospitalization. High cervical spinal cord injuries can easily lead to cardiac arrest due to airway stimulation, such as suctioning. Therefore, early consideration of PPM placement is necessary for safe airway management and rehabilitation.