REBOA and its effect on hemodynamics and cerebral blood flow as measured by CTP in a large animal model of raised intracranial pressure and hemorrhagic shock.

Abstract Hemorrhage is among the leading causes of preventable deaths in trauma. Further traumatic brain injury (TBI) often present in a polytrauma patient, and is known to worsen outcomes when present with non compressible torso hemorrhage (NCTH). Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed as a means of hemorrhage control and afterload increase during a state of hemorrhagic shock, but its use in patients with both hemorrhagic shock and concomitant TBI is controversial, as the potential for ischemia reperfusion injury and acute hypertension may cause intracranial lesion progression. To date, there is limited data on how REBOA alters hemodynamics in a model of hemorrhagic shock and brain injury resulting in raised intracranial pressure. The goal of the current study is to define how full REBOA and partial REBOA alter systemic and cerebral hemodynamics in a porcine model of TBI with raised ICP with concomitant hemorrhagic shock. This will be examined throughout the intervention and for 3 hours of resuscitation. It will be evaluated with hemodynamic, laboratory, and radiographic assessments.