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

Abstract

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. 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. 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). This is the first study to show that prolonged p-REBOA is associated with worse neurologic outcomes, independent of the brain lesion size.