Document Type : original article

Authors

1 Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran.

2 Associated Professor Fellowship Of Critical Care Faculty Of Medicine Department Of Anesthesia Kerman University of Medical Sciences Kerman Iran.

Abstract

Background: Traumatic Brain Injury (TBI) in children is one of the most common causes of death and disability in children. Cardiac arrhythmias can be cited as one of the main factors influencing the mortality and morbidity of these children. The purpose of this study was to investigate the frequency and types of cardiac arrhythmias in children with TBI in the Intensive Care Unit (ICU) of Bahonar Hospital in Kerman.
Methods: This study is a cross-sectional descriptive-analytical study examining patients under 18 years of age who were admitted to the ICU with TBI during 2018-2019 for cardiac arrhythmias. Data were collected using a checklist, including demographic characteristics and other variables in the patient’s file. Finally, the data were analyzed using SPSS version 22.
Results: Forty-six of the 240 traumatized patients admitted to the ICU developed cardiac arrhythmias, the most common of which was sinus tachycardia. The incidence of arrhythmias was significantly higher in patients with subarachnoid hemorrhage (SAH), cerebral contusion, and intracerebral hemorrhage (ICH) than in those with other brain lesions. Most bradycardia was seen in mixed lesions. Dangerous arrhythmias, such as bradycardia and ventricular tachycardia (VT), were also significantly more common in the severe trauma group.
Conclusion: It seems that in children with a head injury, the incidence of cardiac arrhythmias is significantly associated with the Glasgow Coma Scale (GCS) and some lesions due to brain trauma such as SAH, ICH, and brain contusion.

Keywords

  1. Karimi yk, amirjamshidi a. Traumatic brain injuries in children. 2017.
  2. Meshkini A SF, Salimimehr N. Clinical and laboratory symptoms in pediatric stroke. Medical Journal of tabriz university of medical sciences. 2009; 31(2):95-9.
  3. Guthrie E MJ, Richards P, McQuaid M, Pavlakis S. Traumatic brain injury in children and adolescents. Child and adolescent psychiatric clinics of North America. 1999; 8(4):807-26.
  4. Kim SW JH, Kim JY, Kim Y. Heart Rate Variability among Children with Acquired Brain Injury. Annals of Rehabilitation Medicine. 2017; 41(6):951-60.
  5. Lim H, Smith M. Systemic complications after head injury: a clinical review. Anaesthesia. 2007; 62(5):474-82.
  6. Macmillan C, Grant I, Andrews P. Pulmonary and cardiac sequelae of subarachnoid hemorrhage: time for active management? Intensive care medicine. 2002; 28(8):1012-23.
  7. Kothavale A, Banki NM, Kopelnik A, Yarlagadda S, Lawton MT, Ko N, Smith WS, Drew B, Foster E, Zaroff JG. Predictors of left ventricular regional wall motion abnormalities after subarachnoid hemorrhage. Neurocritical Care. 2006; 4(3):199-205.
  8. Clifton GL, Ziegler MG, Grossman RG. Circulating catecholamines and sympathetic activity after head injury. Neurosurgery. 1981; 8(1):10-4.
  9. HERSCH C. Electrocardiographic changes in head injuries. Circulation. 1961; 23(6):853-60.
  10. Jachuck S, Ramani P, Clark F, Kalbag R. Electrocardiographic abnormalities associated with raised intracranial pressure. Br Med J. 1975; 1(5952):242-4.
  11. Cheung RT, Hachinski V. The insula and cerebrogenic sudden death. Archives of Neurology. 2000; 57(12):1685-8.
  12. Collier BR, Miller SL, Kramer GS, Balon JA, Gonzalez III LS. Traumatic subarachnoid hemorrhage and QTc prolongation. Journal of neurosurgical anesthesiology. 2004; 16(3):196-200.
  13. Mann DL, Kent RL, Parsons B, Cooper 4th G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation. 1992; 85(2):790-804.
  14. Clifton GL, McCormick WF, Grossman RG. Neuropathology of early and late deaths after head injury. Neurosurgery. 1981; 8(3):309-14.
  15. Hüttemann E, Schelenz C, Chatzinikolaou K, Reinhart K. Left ventricular dysfunction in lethal severe brain injury: impact of transesophageal echocardiography on patient management. Intensive care medicine. 2002; 28(8):1084-8.
  16. Dujardin KS, McCully RB, Wijdicks EF, Tazelaar HD, Seward JB, McGregor CG, Olson IJ. Myocardial dysfunction associated with brain death: clinical, echocardiographic, and pathologic features. The Journal of heart and lung transplantation. 2001; 20(3):350-7.
  17. Mayer SA GL, Sherman D, Lennihan L, Fink ME. Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. Journal of Neurosurgery. 1995; 83:889-96.
  18. Kocsis B, Fedina L, Pasztor E. Effect of preexisting brain ischemia on sympathetic nerve response to intracranial hypertension. Journal of Applied Physiology. 1991; 70(5):2181-7.
  19. Mahoney EJ, Biffl WL, Harrington DT, Cioffi WG. Isolated brain injury as a cause of hypotension in the blunt trauma patient. Journal of Trauma and Acute Care Surgery. 2003; 55(6):1065-9.
  20. Randall M. Neurogenic hypotension in patients with severe head injuries. J trauma. 1998; 44:958-64.
  21. Grunsfeld A FJ, Nathan BR. Cardiopulmonary complications of brain injury. Curr Neurol Neurosci Rep. 2005; 5:488-93.
  22. Gregory T, Smith M. Cardiovascular complications of brain injury. Continuing Education in Anesthesia, Critical Care & Pain. 2012; 12(2):67-71.
  23. Goldstein B, Kempski MH, DeKing DB, Cox C, DeLong DJ, Kelly MM, Woolf PD. Autonomic control of heart rate after brain injury in children. Critical care medicine. 1996; 24(2):234-40.
  24. Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac dysfunction after neurologic injury: what do we know and where are we going? Chest. 2016; 149(5):1325-31.
  25. Abhik K. Biswas WAS, John F. Sommerauer, Peter M. Luckett. Heart rate variability after acute traumatic brain injury in children. Critical Care Medicine. 2000; 28(12):3907-12.
  26. Grosse-Wortmann L, Bindl L, Seghaye M-C. Multiple types of cardiac arrhythmias in a child with head injury and raised intracranial pressure. Pediatric cardiology. 2006; 27(2):286-8.
  27. Novakoski M, Gvozdenović A, Kelečić M, Gopčević A, Mazul-Sunko B, Širanović M, Fotivec A, Vukić M, Negovetić L, Perić M. Correlation between Glasgow Coma Scale Score and intracranial pressure in patients with severe head injury. Acta clinica Croatica. 2001; 40(3):191-5.
  28. Bourdages M, Bigras J-L, Farrell CA, Hutchison JS, Lacroix J. Cardiac arrhythmias associated with severe traumatic brain injury and hypothermia therapy. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2010; 11(3):408-14.
  29. Kanev MD P. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. 2005.
  30. Osborn JJ. Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. American Journal of Physiology-Legacy Content. 1953; 175(3):389-98.
  31. Abrishamkar S, Fard SA, Momeni A, Irii AR, Rohanizadegan M. QT Interval Changes in Moderate and Severe Brain Injuries. Neurosurgery Quarterly. 2012; 22(2):123-5.
  32. Suman S, Kumar N, Singh Y, Kumar V, Yadav G, Gupta BK, Pandey A R, Pandey S. Evaluation of serum electrolytes in traumatic brain injury patients: prospective randomized observational study. J Anaesth Crit Care Open Access. 2016; 5(3):00184.
  33. Mierzewska-Schmidt M, Gawecka A. Neurogenic stunned myocardium—do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure? Anaesthesiology intensive therapy. 2015; 47(2):175-80.
  34. Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. Journal of critical care. 2017; 38:27-34.