Abstract
The aim of this study was to evaluate the frequency of electrocardiographic (ECG) abnormalities in the acute phase of severe traumatic brain injury (TBI) and the association with brain injury severity and outcome. In contrast to neurovascular diseases, sparse information is available on this issue. Data of adult patients with severe TBI admitted to the Intensive Care Unit (ICU) for intracranial pressure monitoring of a level-1 trauma center from 2002 till 2018 were analyzed. Patients with a cardiac history were excluded. An ECG recording was obtained within 24 h after ICU admission. Admission brain computerized tomography (CT)-scans were categorized by Marshall-criteria (diffuse vs. mass lesions) and for location of traumatic lesions. CT-characteristics and maximum Therapy Intensity Level (TILmax) were used as indicators for brain injury severity. We analyzed data of 198 patients, mean (SD) age of 40 ± 19 years, median GCS score 3 [interquartile range (IQR) 3–6], and 105 patients (53%) had thoracic injury. In-hospital mortality was 30%, with sudden death by cardiac arrest in four patients. The incidence of ECG abnormalities was 88% comprising ventricular repolarization disorders (57%) mostly with ST-segment abnormalities, conduction disorders (45%) mostly with QTc-prolongation, and arrhythmias (38%) mostly of supraventricular origin. More cardiac arrhythmias were observed with increased grading of diffuse brain injury (p = 0.042) or in patients treated with hyperosmolar therapy (TILmax) (65%, p = 0.022). No association was found between ECG abnormalities and location of brain lesions nor with thoracic injury. Multivariate analysis with baseline outcome predictors showed that cardiac arrhythmias were not independently associated with in-hospital mortality (p = 0.097). Only hypotension (p = 0.029) and diffuse brain injury (p = 0.017) were associated with in-hospital mortality. In conclusion, a high incidence of ECG abnormalities was observed in patients with severe TBI in the acute phase after injury. No association between ECG abnormalities and location of brain lesions or presence of thoracic injury was present. Cardiac arrhythmias were indicative for brain injury severity but not independently associated with in-hospital mortality. Therefore, our findings likely suggest that ECG abnormalities should be considered as cardiac mimicry representing the secondary effect of traumatic brain injury allowing for a more rationale use of neuroprotective measures.
Highlights
MATERIALS AND METHODSTraumatic brain injury (TBI) is an important cause of mortality and morbidity in adults [1]
Patients with severe traumatic brain injury (TBI) are initially stabilized at the Emergency Department (ED) and admitted to the Intensive Care Unit (ICU) for treatment based on intracranial pressure (ICP)monitoring to prevent secondary deterioration of brain injury and optimize conditions for brain recovery [2,3,4]
In various neurological and neurosurgical conditions ECG abnormalities are described caused by an elevated sympathetic tone with excessive catecholamine release which can lead to ECG changes that suggest primary myocardial dysfunction and ischemia [6]
Summary
Traumatic brain injury (TBI) is an important cause of mortality and morbidity in adults [1]. We determined the incidence of ECG abnormalities among patients with severe TBI admitted to the ICU by evaluating early ECG recordings obtained within 24 h after ICU admission This time window was chosen because existing literature suggests that cardiac dysfunction occurs early after brain injury [18]. We assessed the predictive value of these ECG abnormalities on in-hospital mortality In this retrospective study data of patients aged ≥16 years with severe TBI (GCS score
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