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Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32
Vijay Krishnamoorthy1, Sumidtra Prathep1, Deepak Sharma2
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
Insights
Pediatric severe traumatic brain injury (TBI) patients diagnosed with brain death exhibit higher rates of cardiac dysfunction compared to those without brain death, impacting organ donation potential.
Area of Science:
- Pediatric critical care medicine
- Neurocritical care
- Cardiology
Background:
- Cardiac dysfunction is a known complication of brain injury but poorly understood in pediatric severe traumatic brain injury (TBI).
- Understanding cardiac function in brain-dead pediatric TBI patients is crucial for organ donation considerations.
Purpose of the Study:
- To investigate the incidence and characteristics of cardiac dysfunction in pediatric patients with severe TBI.
- To compare cardiac dysfunction between pediatric TBI patients with and without brain death.
Main Methods:
- Retrospective cohort study of pediatric patients with severe TBI (2003-2011).
- Echocardiography performed within 2 weeks of TBI.
- Comparison of cardiac dysfunction (low ejection fraction) in patients with and without brain death.
Main Results:
- 32 patients (2.3%) with severe TBI underwent echocardiography.
- Ten patients had brain death; 22 did not.
- Low ejection fraction occurred in 40% of brain-dead TBI patients versus 4.5% of non-brain-dead TBI patients (OR = 14, P = 0.024).
Conclusions:
- Pediatric severe TBI patients with brain death have a significantly higher incidence of cardiac dysfunction.
- This finding has potential implications for cardiac organ donation protocols in pediatric TBI.
- Further research is warranted to explore these implications.
Background:
Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population.
Materials And Methods:
We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003-2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death.
Results:
In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2-6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024).
Conclusions:
The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.
