Research Reports - Secondary brain injury in trauma patients: The effects of remote ischemic conditioning

J Trauma Acute Care Surg. 2015 Apr;78(4):698-705

Joseph B(1), Pandit V, Zangbar B, Kulvatunyou N, Khalil M, Tang A, O'Keeffe T,
Gries L, Vercruysse G, Friese RS, Rhee P

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 neuron-specific 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, 3-8), and the median head Abbreviated Injury Scale (AIS) score was 3
(interquartile range, 3-5), 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.
LEVEL OF EVIDENCE: Therapeutic study, level III.

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