Wide-Complex Tachycardia in Adolescents With Traumatic Brain Injury Receiving Propofol: Case Series

Tuesday, March 24, 2026

10:00 AM - 11:00 AM Central Time

Location: Connections Central - RST 07

Yshia Langer, M.D (he/him/his)

Yerushalayim, Israel

Disclosure(s): No relevant financial relationship(s) to disclose.
UP

Uri Polak, n/a

Dr
Hadassah Medical Center, Israel

Disclosure information not submitted.
AA

Adi Aran, M.D

Pediatric Critical Care Attending
Hadassha University Medical Center, Jerusalem, Israel

Disclosure information not submitted.
EW

Ezra Weinblatt, M.D

Pediatric Critical Care Attending
Hadassha University Medical Center, Jerusalem, Israel

Disclosure information not submitted.
AY

Ayala Yahav, M.D

Pediatric Critical Care Attending
Scnider Medical Center

Disclosure information not submitted.
IA

Itay Ayalon, M.D

Pediatric Critical Care Attending
Ichilov Medical Center

Disclosure information not submitted.
SF

Shirley Friedman, M.D

Pediatric Critical Care Attending
Ichilov Medical Center

Disclosure information not submitted.
DS

Dekel Stavi, M.D

ICU & ECLS Attending
Ichilov Medical Center

Disclosure information not submitted.

Introduction: Wide-complex tachycardia (WCT) is a rare but life-threatening complication in adolescent intensive care patients without underlying cardiac conditions. Propofol is frequently used for sedation in severe traumatic brain injury (TBI) due to its effective sedation profile and intracranial pressure control properties. Propofol-associated WCT is infrequently reported, resulting in limited clinician awareness. We present a multi-center series to highlight this rare but clinically significant complication.

Description: Three adolescent patients (ages 10, 16 and 19 years) with severe TBI were managed in three separate intensive care units. Sedation protocols included fentanyl and propofol (maximum dose: 3–4 mg/kg/hr), with vasopressors required for cerebral perfusion support. Between days 3 to 5 of ICU admission, each patient developed transient WCT episodes rapidly progressing to sustained arrhythmias with severe hemodynamic instability. Two required venoarterial ECMO support: one patient deteriorated despite ECMO and subsequently died; the second patient experienced prolonged malignant arrhythmias with lack of internal pacemaker capture but stabilized following propofol cessation, subsequently made a full recovery. The third patient developed refractory pulseless WCT and died despite aggressive treatment. Extensive evaluations revealed no alternative cause or additional features of propofol infusion syndrome.

Discussion: Due to its rarity, propofol-associated WCT in adolescents with severe TBI is poorly characterized, resulting in limited global clinical experience. This multi-center series emphasizes the need for increased vigilance among clinicians. Early identification and prompt sedation adjustments may positively influence outcomes. Enhanced case reporting and systematic data collection are essential to better understand the incidence, mechanisms, and risk factors associated with propofol-induced arrhythmias, facilitating safer sedation practices for adolescent neurocritical care patients.