ECG and echocardiographic abnormalities in head injury patients undergoing emergency surgical decompression

 

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Background: Myocardial dysfunction leading to circulatory instability (hypotension) during the perioperative period in traumatic brain injury (TBI). We intended to study myocardial dysfunction in TBI patients undergoing emergency surgical decompression and its association with neurological outcome. Methods: We recruited adult head injury patients undergoing surgery within 48 hours of insult. Preoperatively at bedside, ECG and Echocardiography were done. Postoperatively, patient was followed up for 48 hours with an ECG and an echocardiography. ECG was analyzed for heart rate, intervals (PR, QRS and QTc), morphologic end repolarization abnormalities (MERA), ST segment and T wave changes. Echocardiographic measurements collected were left ventricular ejection fraction (LVEF) and regional wall motion abnormalities (RWMA). GCS status at discharge was recorded. Results: Of 110 patients recruited before surgery: ECG abnormalities were sinus tachycardia (15%), prolonged QTc interval (42%), T wave abnormalities (42%), ST segment abnormalities (11%) and MERA (47%). Echocardiography showed LVEF <50% in 10% and RWMA in 10.8%. After surgery, ECG showed significant increase in sinus tachycardia and T-wave abnormalities, but reduction inprolonged QTc interval and MERA. Echocardiography showed significant decrease in LVEF <50% and RWMA. Presence of LV dysfunction were associated with lower GCS score at discharge. Independent predictors of LV dysfunction were poor GCS motor score and prolonged QT_c interval. Conclusion: Left ventricular dysfunction improved following surgical decompression. Poor LV function was associated with poor admission GCS and prolonged QT_c interval. Patients with poor LV function had lower GCS at discharge.