Thomas Wilson 1,2,3, Vijay Krishnamoorthy MD 1,2, Edward Gibbons MD 4, Ali Rowhani-Rahbar MD MPH PhD 2,5, Adeyinka Adedipe MD 6, Monica S. Vavilala MD 1,2 1 Department of Anesthesiology & Pain Medicine, University of Washington Medicine 2 Harborview Injury Prevention & Research Center, UW Medicine 3 The Ohio State University College of Medicine, 4 Department of Cardiology, UW Medicine 5 Department of Epidemiology, UW Medicine 6 Division of Emergency Medicine, UW Medicine Traumatic brain injury (TBI) is a serious public health concern Acute management of TBI: optimize cerebral perfusion pressure Inadequate perfusion  secondary insult Hypotension increases morbidity/mortality after severe TBI 2 Empiric volume expansion/pressors – potential harm Cardiac dysfunction due to neurologic injury Brain death (severe TBI): systolic dysfunction 30% prevalence Preliminary data - severe TBI (retrospective) 1 Reduced (<50%) left ventricular ejection fraction (LVEF): 12% prevalence Regional wall motion abnormality (RWMA): 18% prevalence Specific Aims: Define cardiac dysfunction after isolated TBI Prevalence – systolic/diastolic dysfunction Risk factors Mild TBI – comparison to severe TBI population Background and Aims: Figure 1. Tissue Doppler analysis of left ventricular compliance obtained from TTE apical 4-chamber. Tracing represents velocity of interventricular septum. Mean end-diastolic ventricular pressure can be estimated using Tissue Doppler with greater sensitivity than mitral inflow velocity alone. E’ = mitral inflow. A’ = atrial kick. Sample image courtesy of Preliminary Report: Cardiac Dysfunction Assessed by Trans- thoracic Echocardiography in Patients with Mild Traumatic Brain Injury Study Design: Sample: 30 patients from Harborview Medical Center with mild TBI Inclusion Criteria Age years Clinical diagnosis of isolated mild TBI No documented history of heart disease Exclusion Criteria Chest/cardiac trauma, cardiac arrest/ need for cardiac resuscitation Outcomes Cardiac dysfunction: LVEF < 50% -or- presence of RWMA Diastolic function (Tissue Doppler, LV inflow Pulse Wave Doppler) Pulmonary edema (B-line score) Data Collection Focused TTE with quantitative and qualitative evaluation of right and left ventricular systolic function, diastolic function, and lung ultrasound. Discussion: First prospective study evaluating cardiac dysfunction after TBI No cardiac dysfunction (LVEF < 50%; RWMA) observed to date Ongoing: Diastolic function analysis Dose-response comparison to severe TBI Comprehensive echo analysis Identify patients at risk of neurocardiogenic injury after TBI Targeted, goal-directed hemodynamic support Support: This work was supported by the Foundation for Anesthesia Education and Research MSARF scholarship. Acknowledgement s: Results: 1.Krishnamoorthy. Preliminary report of cardiac dysfunction after severe TBI McHugh. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study, References: