Bader Sam Er, Brorsson C, Löfgren N, Löfgren F, Blind P-J, Sundström N, Öman M, Olivecrona M
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Surgical and Perioperative Sciences, Anaesthesia and Intensive Care, Umeå University, Umeå, Sweden.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3069-3082. doi: 10.1007/s00068-024-02646-0. Epub 2024 Oct 25.
To assess changes of cerebral haemodynamic and intracranial pressure (ICP) in animals, with or without elevated ICP, during controlled haemorrhagic shock and resuscitation with Total REBOA (tREBOA).
In 22 anaesthetized and normoventilated pigs, after placement of catheters for monitoring invasive proximal blood pressure (pMAP), ICP, and vital parameters, and 60 min stabilisation phase, a controlled haemorrhagic shock (HS), was conducted. In 11 pigs (EICPG), an elevated ICP of 25-30 mmHg at the end HS was achieved by simulating an epidural mass. In 11 pigs (NICPG), the ICP was normal. tREBOA was then applied for 120 min. The changes of pMAP and ICP were followed, and cerebral perfusion pressure (CPP) calculated. The integrity of the autoregulation was estimated using a calculated Modified-Long Pressure Reactivity Index (mL-PRx).
After stabilisation, hemodynamics and physiological parameters were similar and normal in both groups. At the end of the HS, ICP was 16 mmHg in NICPG vs. 32 in EICPG (p = 0.0010). CPP was 30 mmHg in NICPG vs. 6 mmHg in EICPG (p = 0.0254). After aorta occlusion CPP increased immediately in both groups reaching after 15 min up to104 mmHg in NICPG vs. 126 mmHg in EICPG. Cerebrovascular reactivity seems to be altered during bleeding and occlusion phases in both groups with positive mL-PRx. The alteration was more pronounced in EICPG, but reversible in both groups.
tREBOA is lifesaving by restoration the cerebral circulation defined as CPP in animals with HS with normal or elevated ICP. Despite the observation of short episodes of cerebral autoregulation impairment during the occlusion, mainly in EICPG, tREBOA seems to be an effective tool for improving cerebral perfusion in HS that extends the crucial early window sometimes known as the "golden hour" for resuscitation even after a traumatic brain injury.
评估在控制性出血性休克及使用全腔静脉-动脉体外膜肺氧合（tREBOA）复苏过程中，颅内压（ICP）正常或升高的动物脑血流动力学和颅内压的变化。
在22只麻醉且通气正常的猪中，放置导管监测有创近端血压（pMAP）、颅内压及生命体征参数，经过60分钟稳定期后，进行控制性出血性休克（HS）。11只猪（EICPG组）通过模拟硬膜外肿块在HS末期使颅内压升高至25 - 30 mmHg。11只猪（NICPG组）颅内压正常。然后应用tREBOA 120分钟。跟踪pMAP和颅内压的变化，并计算脑灌注压（CPP）。使用计算得出的改良长压反应指数（mL-PRx）评估自动调节的完整性。
稳定后，两组的血流动力学和生理参数相似且正常。HS末期，NICPG组颅内压为16 mmHg，EICPG组为32 mmHg（p = 0.0010）。NICPG组CPP为30 mmHg，EICPG组为6 mmHg（p = 0.0254）。主动脉阻断后，两组CPP立即升高，15分钟后NICPG组达104 mmHg，EICPG组达126 mmHg。两组在出血和阻断阶段脑血管反应性似乎均发生改变，mL-PRx为正值。EICPG组改变更明显，但两组均可逆。
tREBOA通过恢复颅内压正常或升高的出血性休克动物的脑循环（定义为CPP）来挽救生命。尽管在阻断期间观察到主要在EICPG组出现短暂的脑自动调节受损情况，但tREBOA似乎是改善出血性休克时脑灌注的有效工具，即使在创伤性脑损伤后，也能延长有时被称为复苏“黄金小时”的关键早期窗口。
