The tech looking to combat sporting brain injuries

Whatever changes to the rules of sports we make, we’re not going to eliminate head injuries from happening altogether. That’s why innovations from pitchside to ambulances to intensive care units are also needed to help avoid as many deaths and serious disabilities as possible. Alexis Joannides is co-director of the Health Tech Research Centre at Addenbrooke’s Hospital, which won £3 million pounds of funding earlier this year from the National Institute of Health and Care Research to support the development of medical devices, diagnostics and digital technologies. He told me how they were going to use the funds…

Alexis - If you try to make a difference, you have to take a structured approach. There are different parts of the patient pathway that you could tackle. There's preventing the injury in the first place, there's stabilising the patient on the scene and on their way into the emergency department, then there's protecting the brain from further injury in the hours and days after an injury and that happens usually in intensive care, and then there's a whole piece of work and effort around rehabilitation and making sure after an injury you recover back to normal life as far as possible.

James - A lot of different stages then, let's zoom in on one particular part of the timeline as you've outlined it for us, and how we are working to make an improvement there.

Alexis - If we look at acute monitoring, this is usually happening once the patient has come to the emergency department, they've been stabilised, then there is a very vulnerable period, a critical period, that the patient will usually be in critical care or the intensive care unit for severe head injuries. And there your focus is making sure the brain doesn't sustain any extra damage from what has already happened. So historically, neurosurgeons and intensive care physicians focus on brain pressure and making sure that doesn't go over a certain level that affects blood flow to the brain. But there are also other parameters, such as how much oxygen is getting into the brain from the blood, and also the metabolic status of the brain in terms of respiration and general metabolism. What we've been championing for a number of years now is a concept called multimodality monitoring, which is where you can have different readouts of the brain pressure, oxygen levels, chemistry, and metabolic demand. So how do you tackle that? Well, the most important thing is to know what are your readouts in terms of sustaining further injury.

James - Could you just take me through why it's that combination of factors that is critical for medical professionals to have at their disposal during that time.

Alexis - So if you have this combination of factors that enables you to tailor your treatments with the patient, be that giving salt solution to reduce the pressure, increasing the amount of oxygen delivered in the ventilator. So in order to customise what you give, you need to measure it. Now if you say, well, how do we do that? Well, again, there's a number of stages. First, you need a device that allows you to put a number of different probes or thin wire into the brain safely. And then you also need to be able to measure the data and analyse it to work out what best to do. So for example, we've just completed a phase two trial on having an algorithm for optimising the pressure that the brain should be at, with an individual patient. We're also working on a sensor that allows the chemistry, the metabolism to be measured in real time, because historically this would be done as a readout with a four hour time lag. So now we have more up to date information. And then really the ultimate outcome is looking at how the patient does down the line. And this is something that you would start doing at the critical phase before you start looking at what difference you've done down the line.