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

Williams, Aaron M., MD; Bhatti, Umar F., MD; Dennahy, Isabel S., MD; Graham, Nathan J., BS; Nikolian, Vahagn C., MD; Chtraklin, Kiril, DVM; Chang, Panpan, MD; Zhou, Jing, MD; Biesterveld, Ben E., MD; Eliason, Jonathan, MD; Alam, Hasan B., MD

Journal of Trauma and Acute Care Surgery: March 2019 - Volume 86 - Issue 3 - p 415–423
doi: 10.1097/TA.0000000000002149
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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 6 hours. Further fluid resuscitation and vasopressors were administered as needed. At the end of the observation period, brain hemispheric swelling (%) and lesion size (mm3) 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.

CONCLUSION Prolonged application of pREBOA in the setting of TBI does not contribute to early worsening of brain lesion size and edema. However, the addition of TBI to HS-pREBOA may worsen the severity of shock. Providers should be aware of the potential physiologic sequelae induced by TBI.

From the Department of Surgery, University of Michigan, Ann Arbor, Michigan.

Submitted: August 4, 2018, Revised: October 28, 2018, Accepted: November 9, 2018, Published online: November 28, 2018.

This study was presented at the 77th Annual Meeting of the American Association for the Surgery of Trauma, September 26–29, 2018, in San Diego, California.

Address for reprints: Hasan B. Alam, MD, Department of Surgery, University of Michigan Hospital, University of Michigan, 2920 Taubman Center/5331, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5331; email:

© 2019 Lippincott Williams & Wilkins, Inc.