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A2-06

THE PERFLUOROCARBON NVX-108 INCREASED BRAIN

TISSUE OXYGENATION AFTER CONTROLLED CORTICAL

IMPACT BRAIN INJURY IN THE RAT

Saad Mullah

1

, Biswajit Saha

1

, Rania Abutarboush

1

, Ashraful Haque

1

,

Francoise Arnaud

1,2

, Brittany Hazzard

1

, Charles Auker

1

, Richard

McCarron

1,2

, Paula Moon-Massat

1

, Anke Scultetus

1,2

1

Naval Medical Research Center, Neurotrauma, OUMD, Silver

Spring, USA

2

Uniformed Services University of the Health Sciences, Department of

Surgery, Bethesda, USA

Hypoxia is a critical secondary injury mechanism in traumatic brain

injury (TBI), and early intervention to alleviate post-TBI hypoxia

may be beneficial. NVX-108 (NuvOx Pharma, Tucson, AZ), a do-

decafluoropentane perfluorocarbon, was screened for its effect on

brain tissue oxygenation (PbtO

2

) when administered soon after TBI.

Anesthetized rats ventilated with 40% oxygen underwent moderate

controlled cortical impact (CCI) TBI at time 0 (T0). Rats received

either no treatment (NON, n

=

8) or 0.5 ml/kg intravenous (IV) NVX-

108 (NVX, n

=

9) at T15 (15 min after TBI) and T75. Brain tissue

oxygenation was measured non-invasively using phosphorescence

quenching method (PQM). After CCI-TBI, PbtO

2

dropped by

48

6% (p

<

0.001) in the NVX group and by 46

5% (p

<

0.001) in

the NON group compared to baseline. Throughout the rest of the

study period (155 min) PbtO

2

in the NON group never recovered and

remained at the immediate post-injury level (16

2 mm Hg). In NVX

group, NVX-108 infusion resulted in a steady increase in PbtO

2

, and

at T115 it recovered to pre-injury values. At T135, PbtO

2

was sig-

nificantly higher (p

<

0.05) compared to post-injury values. This

increase in PbtO2 was maintained until the end of the study. No

changes were noted in hemodynamics, body temperature, acid-base

balance, electrolytes or hemoglobin concentration. In conclusion, the

perfluorocarbon NVX-108 caused an increase in PbtO

2

following

moderately severe CCI-TBI in rats and should be evaluated further

as a possible immediate treatment for TBI.

Keywords: PbtO2, oxygen therapeutics, phosphorescence, PFC

A2-07

OXYGEN CARRIER M-101 DID NOT CAUSE VASOCON-

STRICTION AND IMPROVED CEREBRAL OXYGENATION

AFTER TBI IN RATS

Rania Abutarboush

1

, Saad Mullah

1

, Biswajit Saha

1

, Ashraful

Haque

1

,

Francoise Arnaud

1,2

,

Charles Auker

1,2

,

Richard

McCarron

1,2

, Paula Moon-Massat

1

, Anke Scultetus

1,2

1

Naval Medical Research Center/ Henry Jackson Foundation, Neu-

rotrauma, Silver Spring, USA

2

Uniformed Services Universityof the Health Sciences, Department of

Surgery, Bethesda, USA

The severity of traumatic brain injury (TBI) may be reduced if ox-

ygen can be rapidly provided to the injured brain. This study eval-

uated if the oxygen-carrier M-101 (Hemarina, France) causes

vasoconstricton of pial vasculature in healthy rats (experiment 1) and

if it improves brain tissue oxygen (PbtO

2

) in rats after controlled-

cortical impact (CCI)-TBI (experiment 2). Experiment 1: M-101 was

infused at 12.5 ml/kg IV over 2 h into anesthetized, healthy rats.

Intravital microscopy was used to assess pial artery diameter over

time. There was a mild (9 mm Hg) increase in the mean arterial

blood pressure (MAP) without constriction of pial arterioles. Ex-

periment 2: Anesthetized rats underwent CCI-TBI. 15 min after in-

jury M-101 was infused IV (12 ml/kg over 1 h). Brain tissue

oxygenation was assessed non-invasively via phosphorescence

quenching method (PQM). In both M-101 and untreated control

(NON) groups, PbtO

2

was

*

30

2 mm Hg pre-injury and decreased

(P

£

0.05) to

*

16

2 mm Hg 15 min after CCI. In the NON group,

PbtO

2

remained

*

50% of baseline until the end of the study. M-101

administration resulted in a sustained increase in PbtO

2

(peak:

25

5 mm Hg), which elevated PbtO

2

to pre-injury values. At the

end of the 155 min observation period, PbtO

2

slowly decreased be-

low pre-injury levels, but was still higher than the NON group.

Histopathology showed no differences between groups, possibly due

to the short study duration. In conclusion, M-101 increased systemic

blood pressures without concurrent cerebral pial vasoconstriction (in

healthy rats) and restored PbtO

2

to 86% of pre-injury for at least

80 min when given soon after CCI-TBI. M-101 should be evaluated

in a clinically relevant large animal model for pre-hospital treatment

of TBI.

Keywords: hemoglobin-based oxygen carrier, oxygen therapeu-

tic, pial microcirculation, brain oxygenation, controlled cortical

impact

A2-08

TREATMENT AND RISK FACTORS FOR POST-TRAUMATIC

EXTERNAL HYDROCEPHALUS FOLLOWING DECOM-

PRESSIVE CRANIECTOMY

Wei Yan

1

, Shi-Di Yang

2

, Qun Wu

1

, Gao Chen

1

, Jian-Min Zhang

1

1

The Second Affiliated Hospital, Zhejiang University, Neurosurgery,

Hangzhou, China

2

Ningbo Medical Treatment Center Lihuili Hospital, Neurosurgery,

Ningbo, China

Objectives:

Both external hydrocyphalus and simple subdural hy-

groma following decomprassive craniectomy (DC) have been ob-

served in a variety of traumatic brain injury (TBI) patients. In the

early stage of most external hydrocyphalus cases, subdural fluid col-

lection is the only significant signs on CT scans. Therefore, it is

difficult to different early-stage external hydrocyphalus from simple

subdural hygroma, resulting in inappropriate treatment and poor

prognosis. In this study we assessed the risk factors for the develop-

ment of external hydrocyphalus after DC, and the treatment strategies

were also discussed.

Methods:

A retrospective analysis was undertaken of TBI patients

treated with DC at The Second Affiliated Hospital, Zhejiang Uni-

versity between January 2012 and December 2013. Risk factors for

hydrocephalus were evaluated by using logistic regression analysis.

Results:

Sixty-one patients with subdural fluid collection after DC

were included in this study. Twenty cases developed clinical evidence

of hydrocyphalus and required a ventriculoperitoneal shunt (VPS).

Intraventricular hematoma (p

=

0.009), interhemispheric hygroma

(p

=

0.003) and the onset time of sudural fluid collection (p

=

0.006)

were independent risk factors for external hydrocyphalus after DC.

VPS and early cranioplasty were effective for external hydrocephalus

patients.

Conclusions:

Our results suggested that intraventricular hematoma,

interhemishperic hygroma and onset time of subdural fluid collection

could be predictors for external hydrocephalus after DC. Early cra-

nioplasty and VPS not subdural peritoneal shunt should be considered

for this clinical entity.

Keywords: Traumatic Brain Injury, Hydrocephalus, Subdural Hy-

groma, Decompressive Craniectomy

A-21