Research Reports - Early propranolol after traumatic brain injury is associated with lower mortality

J Trauma Acute Care Surg. 2016 Jan 21. [Epub ahead of print]

Ko A(1), Harada MY, Barmparas G, Thomsen GM, Alban RF, Bloom M, Chung R, Melo N,
Margulies DR, Ley EJ.

BACKGROUND: Beta adrenergic receptor blockers (BB) administered after trauma
blunt the cascade of immune and inflammatory changes associated with injury. BBs
are associated with improved outcomes after traumatic brain injury (TBI).
Propranolol may be an ideal BB due to its nonselective inhibition and ability to
cross the blood brain barrier. We determined if early administration of
propranolol after TBI is associated with lower mortality.
METHODS: All adults (age ≥ 18) with moderate to severe TBI (head AIS = 3-5)
requiring intensive care unit (ICU) admission at a Level I trauma center from
January 1, 2013 to May 31, 2015 were prospectively entered into a database.
Administration of early propranolol was dosed within 24 hours of admission at 1
mg IV every 6 hours. Patients who received early propranolol after TBI (EPAT)
were compared to those who did not (non-EPAT). Data including demographics,
hospital length of stay (LOS), ICU LOS, and mortality were collected.
RESULTS: Over 29 months, 440 patients with moderate to severe TBI met inclusion
criteria. Early propranolol was administered to 25% (109/440) of patients. The
EPAT cohort was younger (49.6 vs. 60.4 years, p < 0.001), had lower GCS (11.7 vs.
12.4, p = 0.003), lower head AIS (3.6 vs. 3.9, p = 0.001), higher admission HR
(95.8 vs. 88.4 bpm, p = 0.002), and required more days on the ventilator (5.9 vs.
2.6 days, p < 0.001). Similarities were noted in gender, ISS, admission SBP,
hospital LOS, ICU LOS and mortality rate. Multivariate regression showed EPAT was
independently associated with lower mortality (AOR 0.25, p = 0.012).
CONCLUSIONS: After adjusting for predictors of mortality, early administration of
propranolol after TBI was associated with improved survival. Future studies are
needed to identify additional benefits as well as optimal dosing regimens.
LEVEL OF EVIDENCE: Therapeutic Level IV.

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