Intracranial Pulsating Balloon-Based Cardiac-Gated ICP Modulation Impact on Brain Oxygenation: A Proof-of-Concept...

Area of Science:

• Neurocritical care
• Cerebrovascular physiology
• Medical device engineering

Background:

• Improving brain oxygenation is critical for neurocritical care patients.
• Previous studies demonstrated feasibility of cardiac-gated intracranial pressure (ICP) modulation for cerebral blood flow enhancement.
• This study investigated specific ICP modulation protocols to influence brain oxygenation.

Purpose of the Study:

• To assess the feasibility of influencing brain oxygenation using specific ICP modulation protocols.
• To evaluate the efficacy of a cardiac-gated intracranial balloon pump in altering brain tissue oxygen tension (PbtO2).

Main Methods:

• Utilized an electrocardiogram (ECG)-gated intracranial balloon pump with adjustable volume, timing, and duty cycle.
• Tested different protocols in a swine model with normal and elevated ICP.
• Monitored physiological parameters and measured brain tissue oxygen tension (PbtO2) at baseline and after device activation.

Main Results:

• In reduced brain perfusion (ICP > 20 mm Hg, PbtO2 < 15 mm Hg), a late-diastolic-early-systolic inflation/deflation protocol increased PbtO2 by 9% (p < 0.01) and reduced ICP by 12% (p < 0.01).
• An early-systolic-late-diastolic protocol decreased PbtO2 by 4% (p < 0.01) and increased ICP by 5% (p < 0.01).
• No significant changes in brain oxygenation or ICP were observed under normal perfusion conditions.

Conclusions:

• Cardiac-gated intracranial balloon pump activation can modulate cerebral oxygenation and increase PbtO2.
• A late-diastolic pressure rise coupled with an early-systolic pressure drop may enhance flow and improve brain tissue oxygenation.
• Further research is needed to evaluate the translational potential of this device for improving brain tissue oxygenation.