Andrew R Mayer1,2,3,4, Andrew B Dodd1, Josef M Ling1, David D Stephenson1, Julie G Rannou-Latella1, Meghan S Vermillion1, Carissa J Mehos5, Victoria E Johnson6, Andrew P Gigliotti1, Rebecca J Dodd1, Irshad H Chaudry7, Timothy B Meier8,9,10, Douglas H Smith6, Denis E Bragin1,11, Chen Lai12, Chelsea L Wagner12, Vivian A Guedes12, Jessica M Gill12, Rachel Kinsler13. 1. The Mind Research Network/Lovelace Biomedical Research Institute, Albuquerque, New Mexico. 2. Neurology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico. 3. Psychiatry Department, University of New Mexico School of Medicine, Albuquerque, New Mexico. 4. Psychology Department, University of New Mexico School of Medicine, Albuquerque, New Mexico. 5. Neurosciences Department, University of New Mexico School of Medicine, Albuquerque, New Mexico. 6. Department of Neurosurgery and Penn Center for Brain Injury and Repair, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama. 8. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 9. Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI. 10. Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin. 11. Neurosurgery Department, University of New Mexico School of Medicine, Albuquerque, New Mexico. 12. National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland. 13. Enroute Care Group, U.S. Army Aeromedical Research Laboratory, Fort Rucker, Alabama.
Abstract
INTRODUCTION: The pathology resulting from concurrent traumatic brain injury (TBI) and hemorrhagic shock (HS; TBI+HS) are leading causes of mortality and morbidity worldwide following trauma. However, the majority of large animal models of TBI+HS have utilized focal/contusional injuries rather than incorporating the types of brain trauma (closed-head injury caused by dynamic acceleration) that typify human injury. OBJECTIVE: To examine survival rates and effects on biomarkers from rotational TBI with two levels of HS. METHODS: Twenty-two sexually mature Yucatan swine (30.39 ± 2.25 kg; 11 females) therefore underwent either Sham trauma procedures (n = 6) or a dynamic acceleration TBI combined with either 55% (n = 8) or 40% (n = 8) blood loss in this serial study. RESULTS: Survival rates were significantly higher for the TBI+40% (87.5%) relative to TBI+55% (12.5%) cohort, with the majority of TBI+55% animals expiring within 2 h post-trauma from apnea. Blood-based neural biomarkers and immunohistochemistry indicated evidence of diffuse axonal injury (increased NFL/Aβ42), blood-brain barrier breach (increased immunoglobulin G) and inflammation (increased glial fibrillary acidic protein/ionized calcium-binding adaptor molecule 1) in the injured cohorts relative to Shams. Invasive hemodynamic measurements indicated increased shock index and decreased pulse pressure in both injury cohorts, with evidence of partial recovery for invasive hemodynamic measurements in the TBI+40% cohort. Similarly, although both injury groups demonstrated ionic and blood gas abnormalities immediately postinjury, metabolic acidosis continued to increase in the TBI+55% group ∼85 min postinjury. Somewhat surprisingly, both neural and physiological biomarkers showed significant changes within the Sham cohort across the multi-hour experimental procedure, most likely associated with prolonged anesthesia. CONCLUSION: Current results suggest the TBI+55% model may be more appropriate for severe trauma requiring immediate medical attention/standard fluid resuscitation protocols whereas the TBI+40% model may be useful for studies of prolonged field care.
INTRODUCTION: The pathology resulting from concurrent traumatic brain injury (TBI) and hemorrhagic shock (HS; TBI+HS) are leading causes of mortality and morbidity worldwide following trauma. However, the majority of large animal models of TBI+HS have utilized focal/contusional injuries rather than incorporating the types of brain trauma (closed-head injury caused by dynamic acceleration) that typify human injury. OBJECTIVE: To examine survival rates and effects on biomarkers from rotational TBI with two levels of HS. METHODS: Twenty-two sexually mature Yucatan swine (30.39 ± 2.25 kg; 11 females) therefore underwent either Sham trauma procedures (n = 6) or a dynamic acceleration TBI combined with either 55% (n = 8) or 40% (n = 8) blood loss in this serial study. RESULTS: Survival rates were significantly higher for the TBI+40% (87.5%) relative to TBI+55% (12.5%) cohort, with the majority of TBI+55% animals expiring within 2 h post-trauma from apnea. Blood-based neural biomarkers and immunohistochemistry indicated evidence of diffuse axonal injury (increased NFL/Aβ42), blood-brain barrier breach (increased immunoglobulin G) and inflammation (increased glial fibrillary acidic protein/ionized calcium-binding adaptor molecule 1) in the injured cohorts relative to Shams. Invasive hemodynamic measurements indicated increased shock index and decreased pulse pressure in both injury cohorts, with evidence of partial recovery for invasive hemodynamic measurements in the TBI+40% cohort. Similarly, although both injury groups demonstrated ionic and blood gas abnormalities immediately postinjury, metabolic acidosis continued to increase in the TBI+55% group ∼85 min postinjury. Somewhat surprisingly, both neural and physiological biomarkers showed significant changes within the Sham cohort across the multi-hour experimental procedure, most likely associated with prolonged anesthesia. CONCLUSION: Current results suggest the TBI+55% model may be more appropriate for severe trauma requiring immediate medical attention/standard fluid resuscitation protocols whereas the TBI+40% model may be useful for studies of prolonged field care.
Authors: Matthew Miller; James Keith; Jonathan Berman; D Bruce Burlington; Charles Grudzinskas; William Hubbard; Carl Peck; Charles Scott; Irshad H Chaudry Journal: J Trauma Acute Care Surg Date: 2014-06 Impact factor: 3.313
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Authors: Victoria E Johnson; Janice E Stewart; Finn D Begbie; John Q Trojanowski; Douglas H Smith; William Stewart Journal: Brain Date: 2013-01 Impact factor: 13.501
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Authors: Andrew R Mayer; Andrew B Dodd; Julie G Rannou-Latella; David D Stephenson; Rebecca J Dodd; Josef M Ling; Carissa J Mehos; Cidney R Robertson-Benta; Sharvani Pabbathi Reddy; Rachel E Kinsler; Meghan S Vermillion; Andrew P Gigliotti; Veronik Sicard; Amy L Lloyd; Erik B Erhardt; Jessica M Gill; Chen Lai; Vivian A Guedes; Irshad H Chaudry Journal: Crit Care Date: 2021-12-16 Impact factor: 9.097