L. A. Robinson1, P. Arnold3, T. J. McDonald2, S. Berry1, A. Bennett1, J. Howard1, J. L. Green1, R. D. Winfield1 1University Of Kansas Medical Center,Department Of Surgery,Kansas City, KS, USA 2University Of Kansas Health System,Trauma Services,Kansas City, KS, USA 3University Of Kansas Medical Center,Department Of Neurosurgery,Kansas City, KS, USA
Introduction: Gunshot wounds to the brain (GSWB) carry high lethality and uncertain recovery, but aggressive resuscitation has been associated with increased survival and organ donation. Evidence-based recommendations guide resuscitative thoracotomy in trauma victims; a similar approach is needed in GSWB to optimize resource utilization. An immediate question is whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) during trauma resuscitation recover or become organ donors. We hypothesized that patients with GSWB undergoing CPR during trauma resuscitation would not survive to discharge or organ donation.
Methods: We performed a retrospective review of patients with traumatic brain injury (TBI) from June 1, 2011 to May 31, 2016 at our level 1 trauma center. Analysis focused on patients with isolated GSWB who received CPR in the field, at a referring hospital, or the ED, with the primary endpoint of survival and secondary endpoint of organ donation.
Results: There were 74 patients with GSWB. Thirteen patients received CPR during initial resuscitation, with 100% mortality. Four arrived to the ED with signs of life, two of these patients and two with no signs of life had return of spontaneous circulation and survived to admission. There were no organ donors among these patients. The 100% mortality and 0% donation rate among GSWB patients undergoing CPR during initial resuscitation was significantly worse than patients with GSWB not undergoing CPR (23% mortality, 45% donation, both p<0.001) or patients with isolated blunt TBI undergoing CPR during initial resuscitation (n=13, 13% mortality, p<0.001, 0% donation, NS) during the same time period.
Conclusion: Patients with GSWB who require CPR during initial resuscitation do not survive to discharge or organ donation. Aggressive resuscitation of these patients is futile and wastes scarce resources. Based on our data and existing evidence, we propose a novel algorithm to guide the management of patients presenting with GSWB. (Figure 1).
