Traumatic brain injury as a cause of cardiovascular collapse in trauma: Impact brain apnea

Abstract text (incl. references and figure legends)

We report the case of a male patient, 54-year-old, previously autonomous, with a history of dyslipidemia, hepatic steatosis, smoking, alcohol abuse, and inhaled light drugs, that was a victim of a motorcycle crash. He was found next to the motorcycle with an intact helmet.

Upon arrival of the emergency response team after about 7 minutes, he was found in cardiac arrest with PEA rhythm. CPR was started by protocol and endotracheal intubation was performed. After 2 minutes, return of spontaneous circulation was achieved with tachycardia and hypertension. Capnography was 68mmHg. EKG showed no signs of ischemia. GCS 3T and miotic pupils. Hypoglycemia of 58 mg/dL, corrected with dextrose. Tranexamic acid 1g was administered. The patient was transported to the hospital under mechanical ventilation.

At hospital admission, he had a positive cannabinoid assay, normal EKG with negative troponins, CT scan of brain, spine, chest, abdomen and pelvis without acute alterations other than a fracture of the right zygomatic arcade. During hospitalization in the ICU, reversible causes for cardiac arrest were excluded. He performed subsequent CT brain scan at 24h without alterations, normal EEG and MRI brain scan with diffuse axonal lesions but without hypoxic-ischemic lesions. Extubation was performed on day 8. The patient showed progressive neurological improvement increasing in GCS to 15. The patient had adequate responses to past events, although recent and accident memory were affected. Motor rehabilitation was performed achieving standing and walking with support.

Cardiac arrest following cranial trauma is often considered unsurvivable traumatic brain injury (TBI). However, Impact Brain Apnea (IBA), the phenomenon of apnea following TBI, may be a significant and preventable contributor to death attributed to primary injury.

Wilson MH, Hinds J, Grier G, Burns B, Carley S, Davies G. Impact brain apnoea-A forgotten cause of cardiovascular collapse in trauma. Resuscitation.2016

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