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Neurocritical Care
Published in: Neurocritical Care 1/2022

21-03-2022 | Central Nervous System Trauma | Original work

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

Authors: Adeyinka Adedipe, Alexander St. John, Vijay Krishnamoorthy, Xu Wang, Dominik T. Steck, Renata Ferreira, Nathan White, Susan Stern

Published in: Neurocritical Care | Issue 1/2022

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Abstract

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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Metadata
Title
Left Ventricular Function in the Initial Period After Severe Traumatic Brain Injury in Swine
Authors
Adeyinka Adedipe
Alexander St. John
Vijay Krishnamoorthy
Xu Wang
Dominik T. Steck
Renata Ferreira
Nathan White
Susan Stern
Publication date
21-03-2022
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2022
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-022-01468-5

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