Improved Cerebral Perfusion Pressure and Microcirculation by Drag Reducing Polymer-Enforced Resuscitation Fluid After Traumatic Brain Injury and Hemorrhagic Shock

• Published in: Acta neurochirurgica. Supplement Vol. 131; p. 289
• Main Authors: Bragin, Denis E, Bragina, Olga A, Trofimov, Alex, Berliba, Lucy, Kameneva, Marina V, Nemoto, Edwin M
• Format: Journal Article
• Language: English
• Published: Austria 2021
• Subjects: Animals; Blood Pressure; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - therapy; Cerebrovascular Circulation; Intracranial Pressure; Microcirculation; Perfusion; Polymers; Rats; Shock, Hemorrhagic - complications; Shock, Hemorrhagic - therapy; Hemorrhagic shock; Traumatic brain injury; Cerebral blood flow; Arterial pressure; Hypoxia; Hetastarch; Intracranial pressure; Cerebral perfusion pressure; Drag-reducing polymer
• DOI: 10.1007/978-3-030-59436-7_54
• ISSN: 0065-1419

Hemorrhagic shock (HS) after traumatic brain injury (TBI) reduces cerebral perfusion pressure (CPP) and cerebral blood flow (CBF), increasing hypoxia and doubling mortality. Volume expansion with resuscitation fluids (RFs) for HS does not improve CBF and tissue oxygen, while hypervolemia exacerbates brain edema and elevates intracranial pressure (ICP). We tested whether drag-reducing polymers (DRPs), added to isotonic Hetastarch (HES), would improve CBF but prevent ICP increase. TBI was induced in rats by fluid percussion, followed by controlled hemorrhage to mean arterial pressure (MAP) = 40 mmHg. HES-DRP or HES was infused to MAP = 60 mmHg for 1 h, followed by blood reinfusion to MAP = 70 mmHg. Temperature, MAP, ICP, cortical Doppler flux, blood gases, and electrolytes were monitored. Microvascular CBF, tissue hypoxia, and neuronal necrosis were monitored by two-photon laser scanning microscopy 5 h after TBI/HS. TBI/HS reduced CPP and CBF, causing tissue hypoxia. HES-DRP (1.9 ± 0.8 mL) more than HES (4.5 ± 1.8 mL) improved CBF and tissue oxygenation (p < 0.05). In the HES group, ICP increased to 23 ± 4 mmHg (p < 0.05) but in HES-DRP to 12 ± 2 mmHg. The number of dead neurons, microthrombosis, and the contusion volume in HES-DRP were significantly less than in the HES group (p < 0.05). HES-DRP required a smaller volume, which reduced ICP and brain edema.