Cardiac Dysfunction in Traumatic Brain Injury
Condition: Trauma, Head; Cardiac Complication
MeSH terms: Brain Injuries; Brain Injuries, Traumatic; Craniocerebral Trauma
Study type: Observational

Summary: 
      Patients with Head Injury have been associated with varying degree of cardiac dysfunction
      resulting in adverse events during emergency surgery and during recover from head injury.
      This study intends to study the incidence and impact of cardiac dysfunction using
      electrocardiogram, transthoracic echocardiogram and cardiac enzyme levels in head injury
      patients during and following emergency surgery. Our results will facilitate better
      management, guide specific therapy and help in prognostication in this group of patients.
    

Detailed description: 
      Traumatic brain injury (TBI) is a major public health concern and a leading cause of
      traumatic death worldwide. It contributes to significant mortality, morbidity and economic
      costs. TBI along with secondary insults have been associated with worse neurologic and
      clinical outcomes. Post-TBI hypotension (systolic blood pressure <90 mmHg) has been directly
      linked to mortality. Cardiac dysfunction has been documented in TBI and implicated as a cause
      for hypotensive episode during TBI surgery. However in majority of the situations, the cause
      is often unknown, and the treatment is empiric.

      Abnormal electrocardiographic (ECG) findings are associated with various neurologic
      hemorrhages which includes TBI, where both ischemic-like changes and a variety of
      repolarization abnormalities have been described. These changes are thought to be secondary
      to sympathetic over-activity and autonomic imbalance, and are associated with dysfunction
      documented by transthoracic echocardiography and cardiac enzyme elevations. Despite the
      frequency with which TBI affects the general population and the high prevalence of secondary
      end-organ dysfunction after TBI, its potential impact on cardiac function has received little
      attention outside of case reports, small case series & retrospective studies. In our study,
      we intend to evaluate the incidence and impact of cardiac dysfunction on neurological
      outcomes in TBI.

      Methodology: The proposed study is prospective and observational. After obtaining informed
      consent, Adult traumatic brain injury patients posted for surgery are recruited.
      Preoperatively patient's demographic and clinical parameters are recorded.Patient management
      are according to insitutional practice in lines with Brain Trauma Foundation guidelines. ECG,
      transthoracic ECHO and blood levels for Troponin I are tested. Intraoperatively, patient's
      hemodynamics are monitored with EV1000- FLOTRAC sensor using a Radial arterial and central
      venous line conitnuously and important time points during surgery are noted. Intraoperative
      drugs, fluids and any events are noted. In the postoperative period, the same physiological
      parameters including ECG, ECHO and Trop I are recorded for 7 days starting from the day of
      surgery.

      The result from this study will help us understand the nature and the severity of cardiac
      dysfunction in head injured Indian patients requiring surgery. This will help us in improving
      our current practices of perioperative management and minimize secondary insults during the
      patients hospital stay resulting in better neurological outcome.
    

Intervention name(s): Electrocardiogram; Transthoracic Echocardiogram; Cardiac enzyme - Troponin I Levels
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): a 12 lead surface electrocardiogram taken after connecting limb and chest electrodes; Transthoracic echocardiogram performed to evaluate Cardiac function in parasternal - long and short axis, Apical - 4 chamber and 5 chamber views.; Blood sample - venous collected to measure blood troponin - I levels.
Other intervention name(s): ECG; ECHO; TROP-I
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adult patients of head injury requiring emergency intracranial surgery presenting to
        National Institute of Mental health and Neurosciences.
      
Keywords: Cardiac Dysfunction; Traumatic Brain Injury