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Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine.

Publication ,  Journal Article
Adedipe, A; John, AS; Krishnamoorthy, V; Wang, X; Steck, DT; Ferreira, R; White, N; Stern, S
Published in: Neurocrit Care
August 2022

BACKGROUND: Cardiac dysfunction is common in the days after severe traumatic brain injury (TBI) and may contribute to hypotension episodes, leading to worse outcomes. Little is known about cardiac function in the minutes and hours immediately following TBI. By using fluid percussion TBI in a swine model, we aimed to characterize the immediate post injury cardiac function. METHODS: Intubated, anesthetized immature (25.8 ± 1.5 kg) female swine were subjected to severe fluid percussion TBI (4.2 ± 0.2 atm). Beginning at 45 min, simulating hospital arrival, all animals were resuscitated with normal saline (NS), mannitol, and phenylephrine as needed to maintain a cerebral perfusion pressure more than 60 mm Hg and intracranial pressure (ICP) less than 20 mm Hg. Primary outcomes of cardiac function were cardiac output measured by thermodilution and transesophageal echo measurements of cardiac function recorded at prespecified time points and tested for trends over time using linear regression with spline at the time of resuscitation onset. Secondary outcomes included hemodynamic measurements, ICP, and cerebral perfusion pressure. RESULTS: Eighteen animals were included. Post-TBI hemodynamic changes demonstrated an early decrease in mean arterial pressure and cerebral perfusion pressure with a corresponding increase in heart rate and ICP. Immediately after injury, there was a significant decrease in both left atrial area and tissue Doppler imaging e' of the LV lateral wall. In addition, there was a simultaneous increase in LV end diastolic diameter and increase in E/e' ratio of the lateral mitral annulus. All other transesophageal echo measurements demonstrated no significant changes throughout the duration of the experiment. CONCLUSIONS: Traumatic brain injury is associated with cardiac dysfunction and increased mortality, however there is still a limited understanding of the hemodynamic and echocardiographic response associated with TBI. In this study we demonstrate the hemodynamic and echocardiographic changes in the early stages of TBI in swine. The authors hope that these results may help better understanding on the management of patients with severe head injury.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

August 2022

Volume

37

Issue

1

Start / End Page

200 / 208

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Swine
  • Neurology & Neurosurgery
  • Intracranial Pressure
  • Heart Diseases
  • Female
  • Brain Injuries, Traumatic
  • Brain Injuries
  • Animals
  • 4205 Nursing
 

Citation

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Adedipe, A., John, A. S., Krishnamoorthy, V., Wang, X., Steck, D. T., Ferreira, R., … Stern, S. (2022). Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine. Neurocrit Care, 37(1), 200–208. https://doi.org/10.1007/s12028-022-01468-5
Adedipe, Adeyinka, Alexander St John, Vijay Krishnamoorthy, Xu Wang, Dominik T. Steck, Renata Ferreira, Nathan White, and Susan Stern. “Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine.Neurocrit Care 37, no. 1 (August 2022): 200–208. https://doi.org/10.1007/s12028-022-01468-5.
Adedipe A, John AS, Krishnamoorthy V, Wang X, Steck DT, Ferreira R, et al. Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine. Neurocrit Care. 2022 Aug;37(1):200–8.
Adedipe, Adeyinka, et al. “Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine.Neurocrit Care, vol. 37, no. 1, Aug. 2022, pp. 200–08. Pubmed, doi:10.1007/s12028-022-01468-5.
Adedipe A, John AS, Krishnamoorthy V, Wang X, Steck DT, Ferreira R, White N, Stern S. Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine. Neurocrit Care. 2022 Aug;37(1):200–208.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

August 2022

Volume

37

Issue

1

Start / End Page

200 / 208

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Swine
  • Neurology & Neurosurgery
  • Intracranial Pressure
  • Heart Diseases
  • Female
  • Brain Injuries, Traumatic
  • Brain Injuries
  • Animals
  • 4205 Nursing