Prolonged partial aortic occlusion worsens neurologic outcomes without affecting brain lesion size in a swine model of traumatic brain injury and hemorrhage.

Abstract

BACKGROUND: Traumatic brain injury and hemorrhagic shock are the leading causes of death in trauma. The partially occluding resuscitative endovascular balloon occlusion of the aorta (p-REBOA) device has emerged as a tool for hemorrhage control with reduced ischemic consequences, allowing for prolonged use. Prior studies in swine show no increase in brain lesion size with prolonged p-REBOA use, but long-term neurologic outcomes remain unknown. We hypothesized that prolonged p-REBOA deployment would worsen neurological outcomes. METHODS: Female Yorkshire swine (n = 5/group; 37-42 kg) were subjected to a controlled cortical impact and right common iliac artery injury and randomized to either: (1) p-REBOA for 2 hours (p-REBOA group) followed by vascular repair or (2) immediate vascular repair with no p-REBOA for 2 hours (control). Daily neurologic severity scores (0 [normal] to 36 [comatose]) and brain lesion size on day 3 were compared. RESULTS: Blood loss, resuscitation, and physiologic parameters were similar between both the groups. While the brain lesion size did not differ between the two groups ( p = 0.55), neurologic severity scores were significantly worse in the p-REBOA group compared with controls (* p = 0.048 at 48 hours and ** p = 0.006 at 72 hours, respectively). CONCLUSION: This is the first study to show that prolonged p-REBOA is associated with worse neurologic outcomes, independent of the brain lesion size.