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Endovascular Resuscitation and Trauma Management pp 111–119Cite as

REBOA in Traumatic Brain Injuries

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Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

Abstract

Traumatic brain injuries are a considerable global burden for healthcare systems and societies. The cornerstone of management remains the optimization of systemic hemodynamics to ensure the continued perfusion of the injured brain with minimization of secondary injury. However, the new paradigm of damage control resuscitation with permissive hypotension presents potentially contradictory hemodynamic goals in multiply injured patients. Resuscitative endovascular balloon occlusion of the aorta has emerged as a technique that can restore perfusion to proximal vascular beds while arresting downstream hemorrhage. The capability for endovascular interventions to reverse hypotension and promote cerebral perfusion may benefit patients with brain injuries. However, the secondary effects of aortic occlusion may be detrimental to patients in hemorrhagic shock with concomitant traumatic brain injuries. The resultant supraphysiologic blood pressure proximal to the point of occlusion and increased carotid blood flow could contribute to secondary injury by worsening cerebral edema, increasing intracranial pressure, or exacerbating intracranial hemorrhage. Alternative techniques for partial aortic occlusion may provide hemorrhage control while mitigating the hypertension and excessive carotid flow observed with complete aortic occlusion. To date, there is limited clinical or animal data to fully understand the effects of endovascular aortic occlusive technologies in patients with traumatic brain injuries.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of California Medical Center, Sacramento, CA, USA

    Carl A. Beyer

  2. Department of Surgery, Univeristy of Utah, Salt Lake City, UT, USA

    M. Austin Johnson

Authors
  1. Carl A. Beyer
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Corresponding author

Correspondence to M. Austin Johnson .

Editor information

Editors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden

    Tal Hörer

  2. University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Joseph J. DuBose

  3. F. Edward Hebert School of Medicine – “America’s Medical School”, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Todd E. Rasmussen

  4. The Department of Surgery at Uniformed Services, University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA

    Joseph M. White

Expert’s Comments by Edoardo Picetti

Expert’s Comments by Edoardo Picetti

Traumatic brain injury (TBI) is a leading cause of morbidity and mortality worldwide [47]. The presence of extra-cranial hemorrhagic lesions further worsens the outcome for brain injured patients [48]. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a valuable adjunct for the control of massive subdiaphragmatic post-traumatic hemorrhage [49]. Providing an early aortic occlusion, REBOA improves blood pressure and transiently stabilizes patients awaiting definitive hemorrhage control [49]. In this regard, the temporary occlusion of the aorta would seem to be useful in exsanguinating TBI patients with non-compressible torso injuries. However, as has been thoroughly explained in this well-written chapter, the utilization of REBOA in TBI patients presents several concerns, mainly related to arterial blood pressure (ABP) variations during balloon inflation (ABP ↑) and deflation (ABP ↓) phases [11, 39, 50]. New emerging techniques (e.g., partial REBOA), associated with less ABP variations, seem to be promising [11, 51]. More laboratory and clinical studies are needed to better define the role of temporary occlusion techniques in TBI patients with hemorrhagic shock.

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Beyer, C.A., Johnson, M.A. (2020). REBOA in Traumatic Brain Injuries. In: Hörer, T., DuBose, J., Rasmussen, T., White, J. (eds) Endovascular Resuscitation and Trauma Management . Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-25341-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-25341-7_8

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