David Zygun fights for better neurocritical care outcomes
If you’ve ever had a car accident or severe fall, there’s a chance you’ve suffered some degree of brain trauma. Traumatic brain injury (TBI) occurs when the head receives an impact forceful enough to injure the brain. It’s the leading cause of injury and death in otherwise healthy young Canadians, striking without warning and leaving damage that can last a lifetime.
Dr. David Zygun knows better than most just how destructive brain trauma can be. He’s a neurocritical care doctor and a researcher at the Hotchkiss Brain Institute. Eleven years ago, during his clinical clerkship, the challenge of dealing with head injuries sparked Zygun’s interest in neurocritical care. He recalls vividly that patients were coming in and not always doing well.
“That summer, we worked really hard but still had very poor outcomes” he says.
The frustration of seeing some lives destroyed while others with the same injury recovered fully, proved pivotal in Zygun’s decision to specialize in neurocritical care and devote his career to research that would improve outcomes in neural trauma.
Calgary’s Foothills Medical Centre has the second largest trauma unit in Canada, seeing around 120 TBI patients a year, and that’s just the tip of the iceberg says Zygun. That figure excludes the individuals who succumb to their injuries before they reach the intensive care unit (ICU), as well as two to three thousand concussions a year in Calgary alone and untold others who suffer lesser brain injuries and never seek medical attention.
Despite great advances in our understanding of the brain, relatively little is still known about neural trauma. Every TBI presents with a distinct combination of axon and blood vessel tearing and bruising that can leave irreversible cognitive and functional deficits – or worse. The individual nature of the initial injury makes TBI harder for doctors to treat and for researchers to study.
The picture is complicated by secondary injuries: processes that are initiated by the damaged brain that cause further damage. Minimizing secondary injuries, such as cerebral ischemia (insufficient blood flow to the brain), stroke, haemorrhage, swelling, programmed cell death and seizures, is a large part of what Dr. Zygun and his colleagues fight to find new answers for every day. While they can do little to prevent brain injuries from occurring in the first place, Zygun believes that with continued research, we’ll be able to achieve much better secondary injury outcomes over the next decade.
“We’re not going to cure traumatic brain injuries, but we can make the outcomes a little better” he says.
Zygun and his colleagues now routinely use a number of tools to monitor neural trauma. Along with visualizing the TBI with magnetic resonance imaging (MRI), they complete the picture with additional monitoring: putting probes and sensors as close to the site of injury as possible. This data can be used in the ICU to make better informed decisions and for research studies after the patient has left the ward.
“With imaging and additional biological monitoring, we’re able to see how the brain is responding to different stages of injury and whether or not our therapies are having an effect,” he says “so once we know we’re heading in the right direction, we can then direct therapies that are clinically relevant.”
Of course neurocritical care research is a team effort, with highly dedicated clinicians and nurses relying on collaborations with HBI laboratory scientists such as Dr. V. Wee Yong to validate new treatment approaches in the lab. In this way says Zygun, the institute is helping advance outcomes in neurocritical care.
“The ability to work alongside basic and clinical scientists, and test ideas and analyse clinical samples in the lab is one of the real strengths of the HBI,” he says. “Currently, we are looking for new and better ways of minimizing the injury that occurs following trauma to the brain, and the HBI is providing us with a great opportunity to do that”.