Impact of REBOA and Tranexamic Acid on Clot Structure and Secondary Brain Injury Following Severe Polytrauma, Hemorrhagic Shock, and Traumatic Brain Injury
Abstract
Objectives and Rationale: Improvised explosive devices (IEDs) result in a specific injury pattern consisting of tissue injury, bleeding, and brain injury termed dismounted complex blast injury (DCBI), which is common in the military. Current battlefield conditions required prolonged pre-hospital field care. Damage control interventions in this limited resource environment include tranexamic acid (TXA), a medication that promotes clotting, and REBOA, which is a procedure that diverts blood flow away from injury and towards the heart and brain. While these are lifesaving interventions, they have potentially negative consequences on blood clotting, brain injury, and organ function. We aim to more clearly delineate the effects of these strategies to determine which patients will respond favorably to treatment as well as develop potential strategies to mitigate these complications. Combat Casualty Care Research Program Multi-Domain Lifesaving Trauma Innovations Award Subareas: This research is applicable to multiple subareas. TXA and REBOA are therapeutic interventions used for hemorrhage, shock, coagulopathy, transfusion, and stabilization of polytrauma and are used in the far-forward environment. This research will provide increased understanding of the pathophysiology of REBOA and TXA, which will help in the development of strategies to mitigate secondary injuries such as ischemia-reperfusion injury, acute respiratory distress syndrome (ARDS), and coagulation abnormalities. Last, special attention is being paid to the potential effects of these interventions on traumatic brain injury (TBI) in an effort to optimize neurologic outcomes. Potential Clinical Applications, Benefits, and Risks: This research applies specifically to DCBIs that are common in the military, but can be extrapolated to civilian injuries as well. It has direct clinical applications as TXA and REBOA are commonly utilized in modern trauma care, without a complete understanding of how to mitigate their negative consequences, and little is known about their specific effect on brain injury. This data will add to the body of knowledge surrounding these interventions to further delineate how to minimize complications and maximize neurologic outcomes. Projected Timeline: The large animal models of individual DCBI components will begin in early 2020. Local Institutional Animal Care and Use Committee approval for the protocol has already been achieved. Shortly after funding, we will obtain US Army Medical Research and Development Command Office of Research Protections Animal Care and Use Review Office approval. In 2021, the intervention models will be completed. The final year (2022) will consist of dissemination of results in the form of peer-reviewed publications and conference presentations. Benefit for Service Members and Public: This research could have significant impact on current resuscitation protocols in both military and civilian trauma by allowing for targeted intervention in patients based on injury pattern. By selecting the appropriate treatment for the patient, we can reduce the secondary injuries caused by interventions such ischemia reperfusion, coagulation disorders, organ dysfunction, and worsening neurologic outcomes. The benefit is a more targeted form of resuscitation that improves outcomes.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 10, 2021
- Source ID
- W81XWH2010205
Entities
People
- Ernest Moore
Organizations
- United States Army
- University of Colorado Denver