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

Bailey, Zachary S.; Cardiff, Katherine; Yang, Xiaofang; Gilsdorf, Janice; Shear, Deborah A.; Rasmussen, Todd E.; Leung, Lai Yee

doi:10.3389/fneur.2019.01309

Cited by 13 publications

(9 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A cohort of patients who receive REBOA for exsanguinating hemorrhage also have traumatic brain injury (TBI), and the effects of aortic occlusion (AO) on brain injury are not well defined. Whether AO occurs with RT or REBOA, cerebral blood flow, carotid blood flow, and other measures which can affect outcomes have been demonstrated to increase 7–9. Because hypotension and hypertension can be problematic for the injured brain,10–15 AO must be used with caution.…”

Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)

Brenner

Zakhary

Coimbra

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundThe effects of aortic occlusion (AO) on brain injury are not well defined. We examined the impact of AO by resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) on outcomes in the setting of traumatic brain injury (TBI).MethodsPatients sustaining TBI who underwent RT or REBOA in zone 1 (thoracic aorta) from September 2013 to December 2018 were identified. The indication for REBOA or RT was hemodynamic collapse due to hemorrhage below the diaphragm. Primary outcomes included mortality and systemic complications.Results282 patients underwent REBOA or RT. Of these, 76 had mild TBI (40 REBOA, 36 RT) and 206 sustained severe TBI (107 REBOA, 99 RT). Overall, the mean (±SD) age was 42±17 years, with an Injury Severity Score (ISS) of 40±17 and mean systolic blood pressure (SBP) at the time of REBOA or RT of 81±34 mm Hg. REBOA patients had a mean SBP at the time of AO of 78.39±29.45 mm Hg, whereas RT patients had a mean SBP of 83.18±37.87 mm Hg at the time of AO (p=0.24). 55% had ongoing cardiopulmonary resuscitation (CPR) at the time of AO, and the in-hospital mortality was 86%. Binomial logistic regression controlling for TBI severity, age, ISS, SBP at the time of AO, crystalloid infusion, and CPR during AO demonstrated that the odds of mortality are 3.1 times higher for RT compared with REBOA. No significant differences were found in systemic complications between RT and REBOA.DiscussionPatients with TBI who receive REBOA may have improved survival, but no difference in systemic complications, compared with patients who receive RT for the same indication. Although some patients are receiving RT prior to arrest for extrathoracic hemorrhagic shock, these results suggest that REBOA should be considered as an alternative to RT when RT is chosen for the sole purpose of resuscitation in the setting of TBI.Level of evidence4.

show abstract

Section: Introductionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)

Brenner

Zakhary

Coimbra

et al. 2022

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…Hemorrhagic shock in trauma patients often occurs with concomitant TBI; therefore, it is important to understand the relationship between aortic occlusion and cerebral physiology following TBI to maintain optimal physiology of the vital organs. Aortic occlusion increases coronary and cerebral perfusion [7]. According to a reported smooth U-shaped correlation between SBP and TBI outcomes, outcomes can improve as SBP increases up to 135 mmHg [8].…”

Section: Discussionmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely performed as an adjunct to resuscitation or bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It is a crucial adjunct for the maintenance of cerebral and coronary perfusion during resuscitation. However, in polytrauma patients with concomitant neurotrauma, such as traumatic brain injury (TBI) or spinal cord injury, the physiological effects of REBOA are unclear. In this report on REBOA performed in a clinical setting for polytrauma patients with spinal cord injury or TBI, the physiological effects of REBOA in neurotrauma are reviewed.

show abstract

“…While multiple preclinical animal studies have examine the impact of pREBOA in poly trauma models, none have examined this relationship in injury models that raise the intracranial pressure to levels that threaten cerebral herniation, or did not report the baseline ICP for comparison. Further, the effects of REBOA on systemic and hemodynamic parameters are not consistent, likely due to differences in methodology (degree/timing of hemorrhage, means/size of intracranial lesion) [11,12,13]. Thus, the goal of the current study was to better understand how hemodynamic cerebral perfusion parameters change in response to pREBOA or fREBOA treatment in a porcine model of clinically signi cant increase in ICP.…”

Section: Introductionmentioning

confidence: 94%

REBOA and its effect on hemodynamics and cerebral blood flow as measured by CTP in a large animal model of raised intracranial pressure and hemorrhagic shock.

Edwards¹,

Elansary²,

Stonko³

et al. 2022

Preprint

View full text Add to dashboard Cite

Hemorrhage is among the leading causes of preventable deaths in trauma. Further traumatic brain injury (TBI) often present in a polytrauma patient, and is known to worsen outcomes when present with non compressible torso hemorrhage (NCTH). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed as a means of hemorrhage control and afterload increase during a state of hemorrhagic shock, but its use in patients with both hemorrhagic shock and concomitant TBI is controversial, as the potential for ischemia reperfusion injury and acute hypertension may cause intracranial lesion progression. To date, there is limited data on how REBOA alters hemodynamics in a model of hemorrhagic shock and brain injury resulting in raised intracranial pressure. The goal of the current study is to define how full REBOA and partial REBOA alter systemic and cerebral hemodynamics in a porcine model of TBI with raised ICP with concomitant hemorrhagic shock. This will be examined throughout the intervention and for 3 hours of resuscitation. It will be evaluated with hemodynamic, laboratory, and radiographic assessments.

show abstract

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

Cited by 13 publications

References 49 publications

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)

Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be superior to resuscitative thoracotomy (RT) in patients with traumatic brain injury (TBI)

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

REBOA and its effect on hemodynamics and cerebral blood flow as measured by CTP in a large animal model of raised intracranial pressure and hemorrhagic shock.

Contact Info

Product

Resources

About