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Effectiveness of calcium channel blockers in traumatic brain injury patients requiring operative intervention
Tianrun Pan1, Melissa Blatt2, Tania Zielonka2
1Hackensack Meridian School of Medicine, Nutley, NJ, 07110, USA.
Insights
Calcium channel blockers (CCBs) for traumatic brain injury (TBI) patients may increase mortality. This study found CCB use was linked to higher death rates without improving patient outcomes in TBI cases.
Area of Science:
- Neurosurgery
- Critical Care Medicine
- Pharmacology
Background:
- Calcium channel blockers (CCBs) are used for hypertension in traumatic brain injury (TBI).
- Potential risks include hypotension and blunted Cushing's reflex, potentially worsening secondary brain injury.
- The hypothesis was that preoperative CCB use does not improve TBI outcomes.
Purpose of the Study:
- To investigate the association between preoperative calcium channel blocker (CCB) use and outcomes in adult patients with traumatic brain injury (TBI).
Main Methods:
- Retrospective study of 105 adult TBI patients undergoing craniotomy/craniectomy within 6 hours of arrival.
- Patients were grouped based on preoperative CCB exposure.
- Outcomes assessed included mortality, Glasgow Outcome Scale (GOS), ICU and hospital length of stay, and discharge location.
Main Results:
- 33 of 105 patients received preoperative CCBs; groups were similar in injury severity and initial GCS.
- Preoperative CCB use was associated with significantly higher mortality (46.9% vs. 23.3%, p=0.029).
- No significant differences were observed in GOS scores or other secondary outcomes.
Conclusions:
- Preoperative CCB administration in TBI patients may be linked to increased mortality.
- Current evidence suggests CCB use does not improve, and may worsen, outcomes in TBI patients.
Introduction:
In patients with traumatic brain injury (TBI), calcium channel blockers (CCBs) may be used in the early phase to manage hypertension. However, these medications may exacerbate secondary brain injury via hypotension and cerebral vasodilation, blunting Cushing's reflex. We hypothesized that preoperative CCB use does not improve outcomes.
Method:
A retrospective study (2017-2023) at a Level 1 Trauma Center includes adults undergoing craniotomy or craniectomy within 6 h of arrival. Patients were grouped by CCB exposure. Outcomes included mortality, Glasgow Outcome Scale (GOS), ICU days, hospital length of stay, and discharge location.
Result:
Of 105 patients, 33 received CCBs. Groups were similar in injury severity and initial GCS. Preoperative CCB was linked to significantly higher mortality (46.9 % vs. 23.3 %, p = 0.029) without significant GOS differences (p = 0.135). Other outcomes showed no significant differences.
Conclusion:
Preoperative CCB use in TBI patients may be associated with higher mortality without improving outcomes.
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