Organ Donation, an Unexpected Benefit of Aggressive Resuscitation of Trauma Patients Presenting "Dead on Arrival".

Alarhayem AQ, Cohn SM, Muir MT et al.

University of Texas Health Science Center at San Antonio, San Antonio, TX. Electronic address:

Journal of the American College of Surgeons. Mar 2017.

We sought to determine if aggressive resuscitation in trauma patients presenting without vital signs or "dead on arrival" (DOA) was futile. We also sought to determine if organ donation was an unexpected benefit of aggressive resuscitation.We conducted a review of adults presenting to our Level 1 trauma center with no signs of life (pulse = 0; systolic blood pressure = 0; and no evidence of neurologic activity, GCS = 3). Primary outcome was survival to hospital discharge or major organ donation (heart, lung, kidney, liver or pancreas were harvested). We compared our survival rates to that of the National Trauma Data Bank (NTDB) in 2012. Patient demographics, Emergency Department (ED) vital signs and outcomes were analyzed.340 patients presented with no signs of life to our ED following injury (median ISS = 40). There were 7 survivors to discharge, but only 5 (1.5%) were functionally independent (4 were victims of penetrating trauma). Of the 333 non-survivors, 12 patients (3.6%) donated major organs (16 kidneys, 2 hearts, 4 livers, and 2 lungs). An analysis of the NTDB yielded a comparable survival rate for those presenting "DOA", with the overall survival rate being 1.8% (100/5,384); 2.3% for blunt trauma, and 1.4% for penetrating trauma.Trauma patients presenting "Dead on Arrival" rarely (1. 5%) achieve functional independence. However, organ donation appears to be an under-recognized outcome benefit (3.6%) of the resuscitation of injury victims arriving without vital signs.


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