Traumatic Brain Injury May Worsen Clinical Outcomes After Prolonged Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (pREBOA) in Severe Hemorrhagic Shock Model

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 (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

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