Effects of sequential aeromedical evacuations following traumatic brain injury in swine

Francoise G Arnaud; Lt Ashraful Haque; Maj Erica Barkei; Maj Erin Morris; Jordan N Hubbell; Natalie Coschigano; Lcdr Carolyn Gosztyla; Col Debra L Malone; Anke H Scultetus

doi:10.1016/j.injury.2022.09.004

Effects of sequential aeromedical evacuations following traumatic brain injury in swine

Injury. 2022 Nov;53(11):3596-3604. doi: 10.1016/j.injury.2022.09.004. Epub 2022 Sep 15.

Authors

Francoise G Arnaud¹, Lt Ashraful Haque², Maj Erica Barkei³, Maj Erin Morris³, Jordan N Hubbell⁴, Natalie Coschigano⁴, Lcdr Carolyn Gosztyla⁵, Col Debra L Malone⁵, Anke H Scultetus⁶

Affiliations

¹ En Route and Critical Care Department, Naval Medical Research Center, Silver Spring, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
² En Route and Critical Care Department, Naval Medical Research Center, Silver Spring, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA.
³ Veterinary Pathology Services, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
⁴ En Route and Critical Care Department, Naval Medical Research Center, Silver Spring, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, MD, USA; Parsons Corporation, Centreville, VA, USA.
⁵ En Route and Critical Care Department, Naval Medical Research Center, Silver Spring, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
⁶ En Route and Critical Care Department, Naval Medical Research Center, Silver Spring, MD, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed Army Institute of Research, Brain Trauma Neuroprotection Branch, Silver Spring, MD, USA. Electronic address: anke.h.scultetus2.civ@health.mil.

PMID: 36163203
DOI: 10.1016/j.injury.2022.09.004

Abstract

Introduction: Traumatic brain injuries (TBI) represent a significant percentage of critical injuries in military conflicts. Following injury, wounded warfighters are often subjected to multiple aeromedical evacuations (AE) and associated hypobaria, yet the impact in TBI patients remains to be characterized. This study evaluated the impact of two consecutive simulated AEs in a fluid-percussion TBI model in swine to characterize these effects.

Methods: Following instrumentation, anesthetized Yorkshire swine underwent a frontal TBI via fluid-percussion. A hypobaric chamber was then used to simulate AE at simulated cabin pressure equivalent to 8000ft (hypobaria) in a 6 h initial flight on day 3, followed by a 9 h flight on day 6, and were monitored for 14 days. Animals in the normobaria group were subjected to the same steps at sea level while Sham animals in both groups were instrumented but not injured. Parameters measured included physiologic response, intracranial pressure (ICP), hematology, chemistry, and serum cytokines. Histopathology of brain, lung, intestine, and kidney was performed, as well as fluorojade staining to evaluate neurodegeneration. All animals were divided into sub-groups by block randomization utilizing a 2-way ANOVA to analyze independent variables.

Results: Survival was 100% in all groups. Physiologic parameters were largely similar across groups as well during both 6 and 9 h AE. Animals exposed to hypobaria in both the TBI and Sham groups had elevated heart rate (HR) during the 6 h flight (p<0.05). Three animals in the TBI hypo group demonstrated leukocytosis with histologic evidence of meningeal inflammatory response. Expression of serum cytokines was low across all groups. No significant neuronal degeneration was identified in areas away from the site of injury.

Conclusion: Aeromedical evacuation in swine was not associated with significant differences in physiologic measures, cytokine expression or levels of neuronal degeneration. Histological examination revealed higher risk of meningeal inflammatory response and leucocytosis in swine exposed to hypobaria.

Keywords: Aeromedical evacuation; Fluid-percussion injury; Hypobaria; Inflammation; TBI.

MeSH terms

Air Ambulances*
Animals
Brain Injuries, Traumatic*
Cytokines
Disease Models, Animal
Intracranial Pressure
Swine

Substances

Cytokines