Traumatic brain injury may worsen clinical outcomes after prolonged partial resuscitative endovascular balloon occlusion of the aorta in severe hemorrhagic shock model

Abstract

Background: The use of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) in combined hemorrhagic shock (HS) and traumatic brain injury (TBI) has not been well studied. We hypothesized that the use of pREBOA in the setting of TBI would be associated with worse clinical outcomes. Methods: Female Yorkshire swine were randomized to the following groups: HS + TBI; HS + TBI + pREBOA; and HS + pREBOA, (n=5/cohort). Animals in the HS + TBI group were left in shock for a total of 2 hours, whereas animals assigned to pREBOA groups were treated with supraceliac pREBOA deployment (60 minutes) 1 hour into the shock period. All animals were then resuscitated, and physiologic parameters were monitored for six hours. Further fluid resuscitation and vasopressors were administered as needed. At the end of the observation period, brain hemispheric swelling (%) and lesion size (mm 3) were assessed. Results: Mortality was highest in the HS + TBI + pREBOA group (40% [2/5] vs 0% [0/5] in the other groups, p = 0.1). Severity of shock was greatest in the HS + TBI + pREBOA group, as defined by peak lactate levels and pH nadir (p < 0.05). Fluid resuscitation and norepinephrine requirements were significantly higher in the HS + TBI + pREBOA group (p < 0.05). No significant differences were noted in brain hemispheric swelling and lesion size between the groups.

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

“…In this review, two studies included euvolemic animals treated with REBOA as controls. 17,25 A majority of the remainder included only controlled hemorrhage, with severity of hemorrhage ranging widely including variables between 10% and 40% estimated blood volume, 36 25%, 23,27,31,37 35%, 33 40% 17,28,30,35 of estimated blood volume. Two studies report partial REBOA with a goal of proximal SBP: 50 mmHg 32 or 90 mmHg.…”

Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta in Neurotrauma: Three Cases

“…In animal studies, pREBOA performed to allow titrated and controlled low-volume aortic flow distal to the site of occlusion resulted in physiological patterns similar to baseline, with smaller increases in the intracranial pressure and proximal mean arterial pressure, and did not aggravate TBI, although prolonged pREBOA may worsen the severity of shock [9,13].…”

The Effects of Balloon Occlusion of the Aorta on Cerebral Blood Flow, Intracranial Pressure, and Brain Tissue Oxygen Tension in a Rodent Model of Penetrating Ballistic-Like Brain Injury

“…To address this knowledge gap, Shackford et al (10) used a porcine model of cryogenic brain lesion and aortic cross clamping to show no adverse effects on ICP, cerebral blood flow (CBF), or water content. These results were replicated with a controlled cortical impact model and expanded to show no worsening of hemorrhage progression in adult swine (11,12). However, Williams et al (12) demonstrated that TBI may worsen the effects of hemorrhagic shock.…”