Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children
Vijay Krishnamoorthy1, Sumidtra Prathep1, Deepak Sharma2, Yasuki Fujita1, William Armstead3, Monica S Vavilala4
1 Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
2 Department of Anesthesiology and Pain Medicine; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
3 Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
4 Department of Radiology, University of Washington, Seattle, Washington, USA
Department of Anesthesiology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, Washington 98104
Source of Support: NIH R01 N072308 (MSV), NIH R01 RO1 HD57355 (WA), Conflict of Interest: None
Background: Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population.
Materials and Methods: We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003-2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death.
Results: In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2-6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024).
Conclusions: The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.