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The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an

Flora Bird1, Mark Wilson2, Shadman Aziz3

  • 1London's Air Ambulance, The Royal London Hospital, Barts NHS Trust, London, United Kingdom.

International Journal of Surgery (London, England)
|February 4, 2025
PubMed

Insights

One in five patients with severe isolated traumatic brain injury (iTBI) experience early cardiovascular dysfunction (CVD), leading to higher mortality and coagulopathy. Outcomes vary significantly across iTBI severity, necessitating further research.

Area of Science:

  • Neuroscience
  • Cardiology
  • Trauma Surgery

Background:

  • The impact of early cardiovascular dysfunction (CVD) on outcomes in isolated traumatic brain injury (iTBI) remains incompletely understood.
  • Severe iTBI patients often present with complex physiological derangements requiring comprehensive assessment.

Purpose of the Study:

  • To determine the prevalence and characteristics of CVD in the hyper-acute phase of severe iTBI.
  • To compare treatment strategies and patient outcomes between iTBI patients with and without early CVD.

Main Methods:

  • Observational cohort study of severe iTBI patients (Head AIS 3+) from a level 1 trauma center and air ambulance service.
  • CVD defined by tachycardia or bradycardia with hypotension; data collected on physiology, labs, transfusions, and CT scans.
  • Primary outcomes included 28-day mortality and Glasgow Outcome Score (GOS).

Main Results:

  • 20% of 168 severe iTBI patients exhibited early CVD, characterized by greater shock (lactate) and coagulopathy.
  • CVD patients required more transfusions and had higher rates of hypoxic ischemic encephalopathy (HIE).
  • Overall mortality was significantly higher in the CVD group (61% vs. 31%), though not in the most severe head injury subgroup (AIS 5).

Conclusions:

  • Early CVD is prevalent in severe iTBI, associated with increased mortality, coagulopathy, and HIE.
  • Outcomes for iTBI patients with CVD are highly variable across the spectrum of injury severity.
  • Further research is crucial to elucidate the pathophysiology and optimize treatment for iTBI patients with CVD.
Abstract

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