title: Partial Brain Tissue Oxygen Levels Predict Arrhythmia and Prognosis in Patients With Brain Injury.
abstract: The objective of this study was to examine the clinical determinants of incidence and prognosis of arrhythmias in the setting of acute brain injury. Acute brain injury is known to cause electrocardiographic abnormalities and cardiac arrhythmias. The relation between partial brain tissue oxygen (PBTO) and intracranial pressure (ICP) with arrhythmia incidence and prognosis remains unknown. Consecutive patients with acute brain injury and intracranial bleed admitted to the neurosurgical intensive care unit were enrolled in the study. Baseline characteristics [demographics, medical history, etiology of brain injury, Glasgow Coma Scale (GCS) score, blood pressure, and respiratory rate] were documented. Patient's telemetry recordings were reviewed for daily mean heart rates and arrhythmias. If arrhythmia was noted, PBTO levels at the beginning of arrhythmia, ICP, brain tissue temperature, and outcomes were recorded. A total of 106 subjects (53% men, age 39 ± 18 years, 65 traumatic and 41 nontraumatic brain injuries) were studied. Overall, 62% of subjects developed a total of 241 arrhythmia episodes. Ventricular arrhythmias were associated with significantly higher daily mean heart rates, low PBTO levels, and low GCS scores, whereas atrial arrhythmias were associated with lower daily mean heart rates, normal PBTO levels, and higher GCS and ICP. Three or more episodes of arrhythmia predicted worse outcomes, including mortality (P = 0.001). In patients with acute brain injury, poor PBTO levels are associated with higher incidence of ventricular tachyarrhythmias. In contrast, atrial tachyarrhythmias occur in patients with normal PBTO levels and higher ICP. Incidence of ventricular arrhythmia in those with poor PBTO is associated with increased mortality.
authors.affiliation: 1Division of Cardiovascular Diseases and the Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City, KS; 2Cardiovascular Consultants PC, Texas Health, Denton, TX; 3Department of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS; 4Union Hospital Neuroscience, Terre Haute, IN; and 5Creighton University Medical Center, Omaha, NE.
authors.forename: Subba Reddy
authors.initials: SR
authors.lastname: Vanga
authors.forename: Hema
authors.initials: H
authors.lastname: Korlakunta
authors.forename: Sowjanya
authors.initials: S
authors.lastname: Duthuluru
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Pradeep
authors.initials: P
authors.lastname: Narotam
authors.forename: Kay
authors.initials: K
authors.lastname: Ryschon
authors.forename: Syed M
authors.initials: SM
authors.lastname: Mohiuddin
authors.forename: Charles
authors.initials: C
authors.lastname: Porter
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D001921:Brain / Q000378:metabolism / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D013686:Telemetry; D055815:Young Adult
chemical_list: D010100:Oxygen