Citation

Robinson LA, Turco LM, Robinson B, Corsa JG, Mount M, Hamrick AV, Berne J, Mederos DR, McNickle AG, Chestovich PJ, Weinberger J, Grigorian A, Nahmias J, Lee JK, Chow KL, Olson EJ, Pascual JL, Solomon R, Pigneri DA, Ladhani HA, Fraifogl J, Claridge J, Curry T, Costantini TW, Kongwibulwut M, Kaafarani H, San Roman J, Schreiber C, Goldenberg-Sandau A, Hu P, Bosarge PL, Uhlich R, Lunardi N, Usmani F, Sakran JV, Babcock JM, Quispe JC, Lottenberg L, Cabral D, Chang G, Gulmatico J, Parks JJ, Rattan R, Massetti J, Gurney O, Bruns B, Smith AA, Guidry C, Kutcher ME, Logan MS, Kincaid MY, Spalding C, Noorbaksh M, Philp FH, Cragun B, Winfield RD. Trauma Surg. Acute Care Open 2019; 4(1): e000351.

Affiliation

Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.

Copyright

(Copyright © 2019, The author(s) and the American Association for the Surgery of Trauma, Publisher BMJ Publishing Group)

DOI

10.1136/tsaco-2019-000351

PMID

31799416

PMCID

PMC6861103

Abstract

INTRODUCTION: Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.

METHODS: We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation.

RESULTS: 825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation.

CONCLUSION: We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. LEVEL OF EVIDENCE: Level II.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Language: en