Ava Puccio, RN, PhDAssistant Professor
Co-Director, Neurotrauma Clinical Trials Center
Ava M. Puccio, RN, PhD is an assistant professor in the department of neurological surgery and also co-director of the Neurotrauma Clinical Trials Center in collaboration with David O. Okonkwo, MD, PhD.
Dr. Puccio received her bachelor of science degree in neuroscience in 1988 and bachelor degree in nursing in 1994, both from the University of Pittsburgh. In 1995, she joined the Department of Neurological Surgery as a nurse coordinator on the National Acute Brain Injury Study: Hypothermia (NABIS:H) study and also the coordinator for the Brain Trauma Research Center.
Throughout her years of employment as a nurse coordinator, she pursued part-time advanced schooling to graduate with a master’s degree in nursing from the University of Pittsburgh in 2000 and as a university scholar (top 2% of class) from the University of Pittsburgh School of Nursing with a doctoral degree, emphasis in neuroscience in 2008. Her dissertation, “Effect of short periods of normobaric hyperoxia on local brain tissue oxygenation and cerebrospinal fluid oxidative stress markers in severe traumatic brain injury” was published in the Journal of Neurotrauma in 2009.
Dr. Puccio was appointed associate scientist at the Safar Center for Resuscitative Research at the University of Pittsburgh upon completion of her doctorate degree. This was a reflection of her past and continuing collaborations with Patrick Kochanek, MD, C. Edward Dixon, PhD, and Hulya Bayir, MD, as well as multiple critical care medicine fellows.
Dr. Puccio was appointed assistant professor in the Department of Neurological Surgery at the University of Pittsburgh in 2010 and was granted tenure-track in 2013. Dr. Puccio received her adjunct faculty position with The School of Nursing, Department of Acute/Tertiary Care in 2010 with collaborations with Yvette Conley, PhD and Richard Henker, RN, PhD.
Her research has focused on improving outcomes in traumatic brain injury patients, with clinical venues of controlled normothermia, mechanisms of brain oxygenations and exploring genetic variances and expression on outcome and was awarded a K99/R00 NINR grant in 2014, entitled, ‘Transcriptomics in Traumatic Brain Injury: Relationship to Brain Oxygenation and Outcomes’.
With 21 years of clinical trial design, involvement and management, several traumatic brain and spine injury research studies have been completed and are ongoing. Many cutting-edge biomarker and high definition fiber tracking imaging and additional observational research studies are being conducted. Dr. Puccio is a member of the Neurocritical Care Society, Society of Critical Care Medicine, National Neurotrauma Society and currently serves as the secretary/treasurer for the Women in Neurotrauma Research (WiNTR).
Dr. Puccio, along with David Okonkwo, MD, PhD, is the primary investigator for the Neurotrauma Clinical Trials Biorepository. This repository supports the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study. The repository inventories and safeguards biospecimens from 11 TRACK-TBI clinical sites and is the largest centralized collection of biological samples from TBI patients in the United States. Dr. Puccio also serves as a member of the Biospecimens Core, within TRACK-TBI, which serves to validate imaging, proteomic, and genetic biomarkers that will improve classification of TBI, permit appropriate selection and stratification of patients for clinical trials, and contribute to the development of a new taxonomy for TBI.
Specialized Areas of Interest
Dr. Puccio’s specialized areas of interest are exploring secondary injury mechanisms following traumatic brain injury to improve neurological outcomes in mild, moderate and severe traumatic brain injury patients. Focused mechanisms include use of controlled normothermia and hypothermia, brain oxygenation, genetic expression and variances and clinical studies of pharmacotherapy in TBI patients.
RN License: Pennsylvania
Professional Organization Membership
Eastern Nursing Research Society
National Neurotrauma Society
Neurocritical Care Society
Sigma Theta Tau International Nursing Honor Society
Society of Critical Care Medicine
Women in Neurotrauma Research (WINTR)
Education & Training
BS, Neuroscience, University of Pittsburgh, 1988
BSN, Nursing, University of Pittsburgh, 1994
MSN, Nursing, University of Pittsburgh, 2000
PhD, Nursing/Neuroscience, University of Pittsburgh, 2008
Honors & Awards
Ruth Perkins Kuehn Nursing Research Award, 2011
Cold Spring Harbor Scholarship, 2012
Lingsma HF, Yue JK, Maas AI, Steyerberg EW, Manley GT, TRACK-TBI Investigators. Outcome prediction after mild and complicated mild traumatic brain injury: external validation of existing models and identification of new predictors using the TRACK-TBI pilot study. Journal of Neurotrauma32(2):83-94, 2015.
Chmura J, Presson N, Benso S, Puccio AM, Fissel K. A high-definition fiber tracking report for patients with traumatic brain injury and their doctors. Military medicine, 180(3 Suppl):122-34, 2015.
Presson N, Krishnaswamy D, Wagener L, Bird W, Jarbo K, Pathak S, Puccio AM, Benso S, Okonkwo DO, Schneider W. Quantifying white matter structural integrity with high-definition fiber tracking in traumatic brain injury. Military Medicine 180(3 Suppl):109-21, 2015.
McMahon PJ, Panczykowski DM, Yue JK, Puccio AM, Inoue T. Measurement of the glial fibrillary acidic protein and its breakdown products GFAP-BDP biomarker for the detection of traumatic brain injury compared to computed tomography and magnetic resonance imaging. Journal of Neurotrauma 32(8):527-33, 2015.
Salibi PN, Agarwal V, Panczykowski DM, Puccio AM, Sheetz MA. Lifetime attributable risk of cancer from CT among patients surviving severe traumatic brain injury. American Journal of Roentgenology 202(2):397-400, 2014.
Yuh EL, Cooper SR, Mukherjee P, Yue JK, Lingsma HF, TRACK-TBI Investigators. Diffusion tensor imaging for outcome prediction in mild traumatic brain injury: a TRACK-TBI study. Journal of Neurotrauma 31(17):1457-77, 2014.
Wright DW, Yeatts SD, Silbergleit R, Palesch YY, Hertzberg VS, NETT Investigators. Very early administration of progesterone for acute traumatic brain injury. The New England Journal of Medicine 371(26):2457-66, 2014.
Diaz-Arrastia R, Wang KK, Papa L, Sorani MD, Yue JK, Puccio AM, McMahon PJ, Inoue T, Yuh EL, Lingsma HF, Maas AI, Valadka AB, Okonkwo DO, Manley GT; Track-TBI Investigators, Casey IS, Cheong M, Cooper SR, Dams-O'Connor K, Gordon WA, Hricik AJ, Menon DK, Mukherjee P, Schnyer DM, Sinha TK, Vassar MJ. Acute biomarkers of traumatic brain injury: relationship between plasma levels of ubiquitin C-terminal hydrolase-L1 and glial fibrillary acidic protein. J Neurotrauma 31(1):19-25, 2014.
Conley YP, Okonkwo DO, Deslouches S, Alexander S, Puccio AM, Beers SR, Ren D. Mitochondrial polymorphisms impact outcomes after severe traumatic brain injury. J Neurotrauma 31(1):34-41, 2014.
Nwachuku EL, Puccio AM, Fetzick A, Scruggs B, Chang YF, Shutter LA, Okonkwo DO. Intermittent versus continuous cerebrospinal fluid drainage management in adult severe traumatic brain injury: Assessment of intracranial pressure burden. Neurocritical Care 20(1):49-53, 2013.
A complete list of Dr. Puccio's publications can be reviewed through the National Library of Medicine's publication database.
The ultimate goal of Dr. Puccio’s career trajectory is to research innovative treatment paradigms for individualized care of TBI patients, with an emphasis on the secondary injury mechanisms following TBI. Mechanisms include temperature management, brain oxygenation optimization and genetic influences including variations and genomic (for example hypoxic signaling).
Recent clinical trials of pharmacotherapy in TBI patients have not shown efficacy, including a dose-escalation study of the neuroprotective agent NNZ-2566 in patients with moderate to severe TBI (GCS 4-12) and also progesterone, SyNAPSE trial on severe TBI patients. TBI heterogeneity has been indicated as a cause for failure of these trials; however, we are exploring other means to design more effective clinical trials. A recent examination of our internal biomarker samples for progesterone in cerebrospinal fluid and serum of patients enrolled in the SyNAPSE clinical trial, resulted in very low bioavailability within the CSF, a suggestion that the drug may not have achieved it’s full target organ for mechanism of action. More studies need to be performed prior to the design of the next pharmaceutical trial in TBI.
Additional clinical studies include, 1) the prospective collection of demographics, blood and cerebrospinal fluid and neurological outcomes for the Neurotrauma Clinical Trials Center and genetic repositories, 2) collaborative research with the University of Cincinnati examining the impact of brain seizure-like activity (spreading depressions) on recovery from TBI, and with the University of California, San Francisco examining and refining a standard for data collection in TBI studies, suitable for use across the broad spectrum of TBI and to explore novel approaches for classification of the initial injury severity and outcome after TBI, making use of emerging technology, and 3) collaborative translational research with industry to validate a commercial handheld hematoma detector for detection of an intracranial blood clot in the acute setting.