The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury

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.

Role of electrocardiogram findings in predicting 48-h mortality in patients with traumatic brain injury

“…In a study on patients with SAH, 15% of patients with preoperative SAH developed STD [ 25 ]. ST-segment abnormalities were the most commonly reported ventricular repolarization disorders in TBI [ 26 ]. Even in the present study, STD occurred in 15.4% of the total patients with TBI, and the proportion of patients with STD with poor outcome was higher than that of patients with good outcome.…”

Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors

“…In one of the largest series of TBI patients, repolarization abnormalities were present in more than half of the patients. [ 23 ] Conduction disorders such as QT prolongation and arrhythmias were observed in 38% of patients. ECG abnormalities in SAH have been reported as between 49% and 100%.…”

Cerebral Autoregulation and Cardiovascular Physiology Dysfunction in Traumatic Brain Injury Cases: A Brief Review

“…Electrocardiographic (ECG) changes, including morphological changes and rhythm disturbances, are common in TBI. Several studies have shown that ECG changes in patients with severe traumatic brain injury are associated with cardiac dysfunction and increased hospital mortality [50,64,71]. The most common ECG changes in patients with SAH and intracerebral hemorrhage (ICH) are repolarization abnormalities such as QT interval prolongation and morphology changes in ST-segment and T wave.…”

“…Arrhythmias are found more frequently in patients with diffuse brain injury. Even so, abnormalities on the ECG cannot pinpoint the location of the lesion in the brain [71]. A 12-lead ECG may be a helpful screening tool for isolated TBI patients with heart abnormalities prior to additional diagnostic investigations or therapies.…”