Thomas Wilson1,2,3, Vijay Krishnamoorthy MD1,2, Edward Gibbons MD4, Ali Rowhani-Rahbar MD MPH PhD2,5, Adeyinka Adedipe MD6, Monica S. Vavilala MD1,2

1Department of Anesthesiology & Pain Medicine, University of Washington Medicine 2Harborview Injury Prevention & Research Center, UW Medicine 3The Ohio State University College of Medicine, 4Department of Cardiology, UW Medicine 5Department of Epidemiology, UW Medicine 6Division of Emergency Medicine, UW Medicine

Traumatic brain injury (TBI) is a serious public health concern

Acute management of TBI: optimize cerebral perfusion pressure• Inadequate perfusion secondary insult• Hypotension increases morbidity/mortality after severe TBI2

• Empiric volume expansion/pressors – potential harm

Cardiac dysfunction due to neurologic injury• Brain death (severe TBI): systolic dysfunction 30% prevalence

Preliminary data - severe TBI (retrospective)1

• Reduced (<50%) left ventricular ejection fraction (LVEF): 12% prevalence

• Regional wall motion abnormality (RWMA): 18% prevalence

Specific Aims: Define cardiac dysfunction after isolated TBI• Prevalence – systolic/diastolic dysfunction• Risk factors• Mild TBI – comparison to severe TBI population

Background and Aims:

Figure 1. Tissue Doppler analysis of left ventricular compliance obtained from TTE apical 4-chamber. Tracing represents velocity of interventricular septum. Mean end-diastolic ventricular pressure can be estimated using Tissue Doppler with greater sensitivity than mitral inflow velocity alone. E’ = mitral inflow. A’ = atrial kick. Sample image courtesy of www.echocardiographer.org.

Preliminary Report: Cardiac Dysfunction Assessed by Trans-thoracic Echocardiography in Patients with Mild Traumatic Brain

Injury

Study Design:

Sample: 30 patients from Harborview Medical Center with mild TBIInclusion Criteria• Age 18-60 years• Clinical diagnosis of isolated mild TBI• No documented history of heart diseaseExclusion Criteria• Chest/cardiac trauma, cardiac arrest/ need for cardiac

resuscitation

Outcomes• Cardiac dysfunction: LVEF < 50% -or- presence of RWMA• Diastolic function (Tissue Doppler, LV inflow Pulse Wave

Doppler)• Pulmonary edema (B-line score)Data Collection• Focused TTE with quantitative and qualitative evaluation of

right and left ventricular systolic function, diastolic function, and lung ultrasound.

Discussion:

• First prospective study evaluating cardiac dysfunction after TBI

• No cardiac dysfunction (LVEF < 50%; RWMA) observed to date

• Ongoing: • Diastolic function analysis• Dose-response comparison to severe TBI

• Comprehensive echo analysis• Identify patients at risk of neurocardiogenic injury after TBI

• Targeted, goal-directed hemodynamic support

Support: This work was supported by the Foundation for Anesthesia Education and Research MSARF scholarship.

Acknowledgements:

Results: Results:

1. Krishnamoorthy. Preliminary report of cardiac dysfunction after severe TBI. 2014.

2. McHugh. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study, 2007.

References: