Cerebral blood flow augmentation using a cardiac-gated intracranial pulsating balloon pump in a swine model of elevated ICP

Restricted access

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

OBJECTIVE

Augmenting brain perfusion or reducing intracranial pressure (ICP) dose is the end target of many therapies in the neuro-critical care unit. Many present therapies rely on aggressive systemic interventions that may lead to untoward effects. Previous studies have used a cardiac-gated intracranial balloon pump (ICBP) to model hydrocephalus or to flatten the ICP waveform. The authors sought to sought to optimize ICBP activation parameters to improve cerebral physiological parameters in a swine model of raised ICP.

METHODS

The authors developed a cardiac-gated ICBP in which the volume, timing, and duty cycle (time relative to a single cardiac cycle) of balloon inflation could be altered. They studied the ICBP in a swine model of elevated ICP attained by continuous intracranial fluid infusion with continuous monitoring of systemic and cerebral physiological parameters, and defined two specific protocols of ICBP activation.

RESULTS

Eleven swine were studied, 3 of which were studied to define the optimal timing, volume, and duty cycle of balloon inflation. Eight swine were studied with two defined protocols at baseline and with ICP gradually raised to a mean of 30.5 mm Hg. ICBP activation caused a consistent modification of the ICP waveform. Two ICBP activation protocols were used. Balloon activation protocol A led to a consistent elevation in cerebral blood flow (8%–25% above baseline, p < 0.00001). Protocol B resulted in a modest reduction of ICP over time (8%–11%, p < 0.0001) at all ICP levels. Neither protocol significantly affected systemic physiological parameters.

CONCLUSIONS

The preliminary results indicate that optimized protocols of ICBP activation may have beneficial effects on cerebral physiological parameters, with minimal effect on systemic parameters. Further studies are warranted to explore whether ICBP protocols may be of clinical benefit in patients with brain injuries with increased ICP.

ABBREVIATIONS ABP = arterial blood pressure; CBF = cerebral blood flow; ICBP = intracranial balloon pump; ICP = intracranial pressure.
Article Information

Contributor Notes

Correspondence Omer Doron: Hadassah-Hebrew University Medical Center, Jerusalem, Israel. omerdoronmd@gmail.com.INCLUDE WHEN CITING Published online April 12, 2019; DOI: 10.3171/2019.1.JNS182864.Disclosures Dr. Doron and Professor Barnea are listed as inventors on a patent of the device presented in this work.
Headings
References
  • 1

    Ambarki KBaledent OKongolo GBouzerar RFall SMeyer ME: A new lumped-parameter model of cerebrospinal hydrodynamics during the cardiac cycle in healthy volunteers. IEEE Trans Biomed Eng 54:4834912007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bederson JBConnolly ES JrBatjer HHDacey RGDion JEDiringer MN: Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 40:99410252009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Carney NTotten AMO’Reilly CUllman JSHawryluk GWBell MJ: Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 80:6152017

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Di Rocco CPettorossi VECaldarelli MMancinelli RVelardi F: Experimental hydrocephalus following mechanical increment of intraventricular pulse pressure. Experientia 33:147014721977

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Friess SHRalston JEucker SAHelfaer MASmith CMargulies SS: Neurocritical care monitoring correlates with neuropathology in a swine model of pediatric traumatic brain injury. Neurosurgery 69:113911472011

    • Search Google Scholar
    • Export Citation
  • 6

    Hawryluk GWPhan NFerguson ARMorabito DDerugin NStewart CL: Brain tissue oxygen tension and its response to physiological manipulations: influence of distance from injury site in a swine model of traumatic brain injury. J Neurosurg 125:121712282016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Hemphill JC IIIKnudson MMDerugin NMorabito DManley GT: Carbon dioxide reactivity and pressure autoregulation of brain tissue oxygen. Neurosurgery 48:3773842001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Hlatky RValadka ABGopinath SPRobertson CS: Brain tissue oxygen tension response to induced hyperoxia reduced in hypoperfused brain. J Neurosurg 108:53582008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kiening KLUnterberg AWBardt TFSchneider GHLanksch WR: Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85:7517571996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Krishnamurthy SLi JSchultz LMcAllister JP II: Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus. Cerebrospinal Fluid Res 6:162009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Löfgren Jvon Essen CZwetnow NN: The pressure-volume curve of the cerebrospinal fluid space in dogs. Acta Neurol Scand 49:5575741973

  • 12

    Longhi LPagan FValeriani VMagnoni SZanier ERConte V: Monitoring brain tissue oxygen tension in brain-injured patients reveals hypoxic episodes in normal-appearing and in peri-focal tissue. Intensive Care Med 33:213621422007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Luciano MGDombrowski SMQvarlander SEl-Khoury SYang JThyagaraj S: Novel method for dynamic control of intracranial pressure. J Neurosurg 126:162916402017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Nilsson FAkeson JMesseter KRyding ERosén INordström CH: A porcine model for evaluation of cerebral haemodynamics and metabolism during increased intracranial pressure. Acta Anaesthesiol Scand 39:8278341995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Odland RMVenugopal SBorgos JCoppes VMcKinney AMRockswold G: Efficacy of reductive ventricular osmotherapy in a swine model of traumatic brain injury. Neurosurgery 70:4454552012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Preuss MHoffmann KTReiss-Zimmermann MHirsch WMerkenschlager AMeixensberger J: Updated physiology and pathophysiology of CSF circulation—the pulsatile vector theory. Childs Nerv Syst 29:181118252013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ramirez de Noriega FManley GTMoscovici SItshayek ETamir IFellig Y: A swine model of intracellular cerebral edema—cerebral physiology and intracranial compliance. J Clin Neurosci 58:1921992018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Rosenthal GHemphill JC IIISorani MMartin CMorabito DMeeker M: The role of lung function in brain tissue oxygenation following traumatic brain injury. J Neurosurg 108:59652008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Rosenthal GHemphill JC IIISorani MMartin CMorabito DObrist WD: Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med 36:191719242008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Scheufler KMRöhrborn HJZentner J: Does tissue oxygen-tension reliably reflect cerebral oxygen delivery and consumption? Anesth Analg 95:104210482002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Vik ANag TFredriksli OASkandsen TMoen KGSchirmer-Mikalsen K: Relationship of “dose” of intracranial hypertension to outcome in severe traumatic brain injury. J Neurosurg 109:6786842008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Wagshul MEEide PKMadsen JR: The pulsating brain: a review of experimental and clinical studies of intracranial pulsatility. Fluids Barriers CNS 8:52011

    • Crossref
    • Search Google Scholar
    • Export Citation
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 523 271 19
Full Text Views 96 50 2
PDF Downloads 71 44 2
EPUB Downloads 0 0 0
PubMed
Google Scholar