Research Reports - Preliminary report on cardiac dysfunction after isolated traumatic brain injury

Crit Care Med. 2014 Jan;42(1):142-7

Prathep S, Sharma D, Hallman M, Joffe A, Krishnamoorthy V, Mackensen GB, Vavilala MS

OBJECTIVE: The aim of this study was to examine cardiac dysfunction during the
first 2 weeks after isolated traumatic brain injury and its association with
in-hospital mortality.
DESIGN: Retrospective.
SETTING: Level 1 regional trauma center.
PATIENTS: Adult patients with severe traumatic brain injury.
METHODS: After institutional review board approval, data from adult patients with
isolated traumatic brain injury who underwent echocardiography during the first 2
weeks after traumatic brain injury between 2003 and 2010 were examined. Patients
with preexisting cardiac disease were excluded. Clinical characteristics and
echocardiogram reports were abstracted. Cardiac dysfunction was defined as left
ventricular ejection fraction less than 50% or presence of regional wall motion
abnormality.
INTERVENTIONS: None.
MEASUREMENT AND MAIN RESULTS: We examined data from 139 patients with isolated
traumatic brain injury who underwent echocardiographic evaluation. Patients were
58 ± 20 years old, 66% were male patients, and 62.6% had subdural hematoma;
admission Glasgow Coma Scale score was 3 ± 1 (3-15) and head Abbreviated Injury
Scale was 4 ± 1 (2-5). Of this cohort, 22.3% had abnormal echocardiogram: reduced
left ventricular ejection fraction was documented in 12% (left ventricular
ejection fraction, 43% ± 8%) and 17.5% of patients had a regional wall motion
abnormality. Hospital day 1 was the most common day of echocardiographic exam.
Abnormal echocardiogram was independently associated with all cause in-hospital
mortality (9.6 [2.3-40.2]; p = 0.002).
CONCLUSIONS: Cardiac dysfunction in the setting of isolated traumatic brain
injury occurs and is associated with increased in-hospital mortality. This
finding raises the question as to whether there are uncharted opportunities for a
more timely recognition of cardiac dysfunction and subsequent optimization of the
hemodynamic management of these patients.

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