Cardiovascular events in children with brain injury: A systematic review

Brain injury is a leading cause of morbidity and mortality in the pediatric population. Neurogenic stunned cardiomyopathy is a complication associated with several neurological conditions that can lead to worse outcomes. It presents as alterations in blood pressure, cardiac rhythm disturbances and the increase in cardiac injury biomarkers. This systematic review aims to assess the hemodynamic consequences of brain injury in the pediatric population to identify better management strategies and improve outcomes. An electronic literature search was performed in Pubmed, Scopus and WebOfScience, up until October 3rd, 2022. The selected articles underwent quality assessment using the National Heart, Lung and Blood Institute tools for cohort and case-control studies. This systematic review includes thirteen articles on the effects of brain injury in arterial pressure, rhythm disturbances and biomarkers of myocardial injury. These studies showed the following key results: both hypotension and hypertension are associated with worse outcomes; brain injury could be related to longer QTc intervals; neurogenic stunned cardiomyopathy was a common found after brain injury. This is the first systematic review to report cardiovascular abnormalities arising from brain injury in children. An early arterial pressure, electrocardiographic and echocardiographic evaluation, as well as the measure of serum biomarkers for myocardial injury, can be critical in identifying poor prognostic factors. Further research is required to understand the implications of our findings in clinical practice. •Severe brain injury in children can have effects on cardiovascular system causing cardiac rhythm disturbances, alterations in blood pressure, and the increase in cardiac injury biomarkers.•Arterial pressure is associated with severe brain injury in children, both hypotension and hypertension are associated with worse outcomes.•Neurogenic stunned cardiomyopathy (NSC) is a complication associated with several neurological conditions that can lead to worse outcomes and tachycardia at the time of admission might be its most common presentation.•Electrocardiographic and echocardiographic evaluation, as well as the measure of serum biomarkers for myocardial injury, can be critical in identifying poor prognostic factors in brain injured children.•Brain injury could be related to longer QTc intervals, a known cause of cardiac arrhythmias.