Secondary brain injury in trauma patients

The effects of remote ischemic conditioning

Bellal Joseph, Viraj Pandit, Bardiya Zangbar, Narong Kulvatunyou, Mazhar Khalil, Andrew Tang, Terence OKeeffe, Lynn Gries, Gary Vercruysse, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Management of traumatic brain injury (TBI) is focused on preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes secondary to inflammatory insults. The aim of our study was to assess whether RIC in trauma patients with severe TBI could reduce secondary brain injury. METHODS: This prospective consented interventional trial included all TBI patients admitted to our Level 1 trauma center with an intracranial hemorrhage and a Glasgow Coma Scale (GCS) score of 8 or lower on admission. In each patient, four cycles of RIC were performed within 1 hour of admission. Each cycle consisted of 5 minutes of controlled upper limb (arm) ischemia followed by 5 minutes of reperfusion using a blood pressure cuff. Serum biomarkers of acute brain injury, S-100B, and neuronspecific enolase (NSE) were measured at 0, 6, and 24 hours. Outcome measure was reduction in the level of serum biomarkers after RIC. RESULTS: A total of 40 patients (RIC, 20; control, 20) were enrolled. The mean (SD) age was 46.15 (18.64) years, the median GCS score was 8 (interquartile range, 3Y8), and the median head Abbreviated Injury Scale (AIS) score was 3 (interquartile range, 3Y5), and there was no difference between the RIC and control groups in any of the baseline demographics or injury characteristics including the type and size of intracranial bleed or skull fracture patterns. There was no difference in the 0-hour S-100B (p = 0.9) and NSE (p = 0.72) level between the RIC and the control group. There was a significant reduction in the mean levels of S-100B (p = 0.01) and NSE (p = 0.04) at 6 hours and 24 hours in comparison with the 0-hour level in the RIC group. CONCLUSION: This study showed that RIC significantly decreased the standard biomarkers of acute brain injury in patients with severe TBI. Our study highlights the novel therapeutic role of RIC for preventing secondary brain insults in TBI patients.

Original languageEnglish (US)
Pages (from-to)698-705
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number4
DOIs
StatePublished - Apr 4 2015
Externally publishedYes

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Brain Injuries
Wounds and Injuries
Phosphopyruvate Hydratase
Glasgow Coma Scale
Biomarkers
Abbreviated Injury Scale
Skull Fractures
Control Groups
Intracranial Hemorrhages
Trauma Centers
Serum
Craniocerebral Trauma
Upper Extremity
Reperfusion
Arm
Ischemia
Demography
Outcome Assessment (Health Care)
Traumatic Brain Injury
Blood Pressure

Keywords

  • neuron-specific enolase
  • Remote ischemic conditioning
  • S-100B
  • traumatic brain injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Khalil, M., Tang, A., ... Rhee, P. (2015). Secondary brain injury in trauma patients: The effects of remote ischemic conditioning. Journal of Trauma and Acute Care Surgery, 78(4), 698-705. https://doi.org/10.1097/TA.0000000000000584

Secondary brain injury in trauma patients : The effects of remote ischemic conditioning. / Joseph, Bellal; Pandit, Viraj; Zangbar, Bardiya; Kulvatunyou, Narong; Khalil, Mazhar; Tang, Andrew; OKeeffe, Terence; Gries, Lynn; Vercruysse, Gary; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 4, 04.04.2015, p. 698-705.

Research output: Contribution to journalArticle

Joseph, B, Pandit, V, Zangbar, B, Kulvatunyou, N, Khalil, M, Tang, A, OKeeffe, T, Gries, L, Vercruysse, G, Friese, RS & Rhee, P 2015, 'Secondary brain injury in trauma patients: The effects of remote ischemic conditioning', Journal of Trauma and Acute Care Surgery, vol. 78, no. 4, pp. 698-705. https://doi.org/10.1097/TA.0000000000000584
Joseph, Bellal ; Pandit, Viraj ; Zangbar, Bardiya ; Kulvatunyou, Narong ; Khalil, Mazhar ; Tang, Andrew ; OKeeffe, Terence ; Gries, Lynn ; Vercruysse, Gary ; Friese, Randall S. ; Rhee, Peter. / Secondary brain injury in trauma patients : The effects of remote ischemic conditioning. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 78, No. 4. pp. 698-705.
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AU - Khalil, Mazhar

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