Kristen D Nordham, Danielle Tatum, Abdallah S Attia, Mayur B Patel, Anil Paramesh, Juan C Duchesne, Jeffry Nahmias, Amelia W Maiga, Allan B Peetz, Pascal O Udekwu, Anquonette Stiles, Chloe Shell, Joshua D Stodghill, Taneen Maghsoudi, Erin Iacullo, Bryant McLafferty, Erin Coonan, Ryan M Boudreau, Steven A Zimmerman, Berje Shammassian, Tanya Egodage, Isabella Aramento, Patrick Morris, Jacob Metheny, Michael S Farrell, Matthew D Painter, Owen T McCabe, Philomene Spadafore, David Tai-Wai Wong, Jan Serrano, Jason D Sciarretta, Phillip Kim, Ryan Hayton, Danessa Gonzales, Jason Murry, Katelyn Meadows, Lewis E Jacobson, Jamie M Williams, Andrew C Bernard, Brennan Smith, Shawna L Morrissey, Nilesh Patel, Dina Tabello, Erik Teicher, Sharfuddin Mahmud Chowdhury, Fazal Ahmad, Basem S Marcos, Michaela A West, Tomas H Jacome, Greggory Davis, Joshua A Marks, Deviney Rattigan, James M Haan, Kelly Lightwine, Kazuhide Matsushima, Stephen Park, Ariel Santos, Kripa Shrestha, Robert Sawyer, Sheri VandenBerg, Robert J Jean, R Chace Hicks, Stephanie Lueckel, Nikolay Bugaev, Wael Abosena, Claudia Alvarez, Mark J Lieser, Hannah McDonald, Ryan P Dumas, Caitlin A Fitzgerald, William Thomas Hillman Terzian, Yuqian Tian, Vasileios Mousafeiris, Francesk Mulita, John D Berne, Dalier R Mederos, Alison A Smith, Sharven Taghavi
{"title":"灾难性脑损伤指南对器官捐献率的影响：EAST 多中心试验结果。","authors":"Kristen D Nordham, Danielle Tatum, Abdallah S Attia, Mayur B Patel, Anil Paramesh, Juan C Duchesne, Jeffry Nahmias, Amelia W Maiga, Allan B Peetz, Pascal O Udekwu, Anquonette Stiles, Chloe Shell, Joshua D Stodghill, Taneen Maghsoudi, Erin Iacullo, Bryant McLafferty, Erin Coonan, Ryan M Boudreau, Steven A Zimmerman, Berje Shammassian, Tanya Egodage, Isabella Aramento, Patrick Morris, Jacob Metheny, Michael S Farrell, Matthew D Painter, Owen T McCabe, Philomene Spadafore, David Tai-Wai Wong, Jan Serrano, Jason D Sciarretta, Phillip Kim, Ryan Hayton, Danessa Gonzales, Jason Murry, Katelyn Meadows, Lewis E Jacobson, Jamie M Williams, Andrew C Bernard, Brennan Smith, Shawna L Morrissey, Nilesh Patel, Dina Tabello, Erik Teicher, Sharfuddin Mahmud Chowdhury, Fazal Ahmad, Basem S Marcos, Michaela A West, Tomas H Jacome, Greggory Davis, Joshua A Marks, Deviney Rattigan, James M Haan, Kelly Lightwine, Kazuhide Matsushima, Stephen Park, Ariel Santos, Kripa Shrestha, Robert Sawyer, Sheri VandenBerg, Robert J Jean, R Chace Hicks, Stephanie Lueckel, Nikolay Bugaev, Wael Abosena, Claudia Alvarez, Mark J Lieser, Hannah McDonald, Ryan P Dumas, Caitlin A Fitzgerald, William Thomas Hillman Terzian, Yuqian Tian, Vasileios Mousafeiris, Francesk Mulita, John D Berne, Dalier R Mederos, Alison A Smith, Sharven Taghavi","doi":"10.1097/TA.0000000000004386","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>One third of organ donors suffer catastrophic brain injury (CBI). There are no standard guidelines for the management of traumatic CBI prior to brain death, and not all trauma centers have institutional CBI guidelines. In addition, there is high variability in management between institutions with guidelines. Catastrophic brain injury guidelines vary and may include various combinations of hormone therapy, vasopressors, fluid resuscitation, and other practices. We hypothesized that centers with CBI guidelines have higher organ donation rates than those without.</p><p><strong>Methods: </strong>This prospective, observational EAST-sponsored multicenter trial included adult (18+ years old) traumatic-mechanism CBI patients at 33 level I and II trauma centers from January 2022 to May 2023. Catastrophic brain injury was defined as a brain injury causing loss of function above the brain stem and subsequent death. Cluster analysis with linear mixed-effects model including UNOS regions and hospital size by bed count was used to determine whether CBI guidelines are associated with organ donation.</p><p><strong>Results: </strong>A total of 790 CBI patients were included in this analysis. In unadjusted comparison, CBI guideline centers had higher rates of organ donation and use of steroids, whole blood, and hormone therapy. In a linear mixed-effects model, CBI guidelines were not associated with organ donation. Registered organ donor status, steroid hormones, and vasopressin were associated with increased relative risk of donation.</p><p><strong>Conclusion: </strong>There is high variability in management of CBI, even at centers with CBI guidelines in place. While the use of institutional CBI guidelines was not associated with increased organ donation, guidelines in this study were not identical. Hormone replacement with steroids and vasopressin was associated with increased donation. Hormone resuscitation is a common feature of CBI guidelines. Further analysis of individual practices that increase organ donation after CBI may allow for more effective guidelines and an overall increase in donation to decrease the long waiting periods for organ transplant recipients.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"117-126"},"PeriodicalIF":2.9000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of catastrophic brain injury guidelines on organ donation rates: Results of an EAST multicenter trial.\",\"authors\":\"Kristen D Nordham, Danielle Tatum, Abdallah S Attia, Mayur B Patel, Anil Paramesh, Juan C Duchesne, Jeffry Nahmias, Amelia W Maiga, Allan B Peetz, Pascal O Udekwu, Anquonette Stiles, Chloe Shell, Joshua D Stodghill, Taneen Maghsoudi, Erin Iacullo, Bryant McLafferty, Erin Coonan, Ryan M Boudreau, Steven A Zimmerman, Berje Shammassian, Tanya Egodage, Isabella Aramento, Patrick Morris, Jacob Metheny, Michael S Farrell, Matthew D Painter, Owen T McCabe, Philomene Spadafore, David Tai-Wai Wong, Jan Serrano, Jason D Sciarretta, Phillip Kim, Ryan Hayton, Danessa Gonzales, Jason Murry, Katelyn Meadows, Lewis E Jacobson, Jamie M Williams, Andrew C Bernard, Brennan Smith, Shawna L Morrissey, Nilesh Patel, Dina Tabello, Erik Teicher, Sharfuddin Mahmud Chowdhury, Fazal Ahmad, Basem S Marcos, Michaela A West, Tomas H Jacome, Greggory Davis, Joshua A Marks, Deviney Rattigan, James M Haan, Kelly Lightwine, Kazuhide Matsushima, Stephen Park, Ariel Santos, Kripa Shrestha, Robert Sawyer, Sheri VandenBerg, Robert J Jean, R Chace Hicks, Stephanie Lueckel, Nikolay Bugaev, Wael Abosena, Claudia Alvarez, Mark J Lieser, Hannah McDonald, Ryan P Dumas, Caitlin A Fitzgerald, William Thomas Hillman Terzian, Yuqian Tian, Vasileios Mousafeiris, Francesk Mulita, John D Berne, Dalier R Mederos, Alison A Smith, Sharven Taghavi\",\"doi\":\"10.1097/TA.0000000000004386\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>One third of organ donors suffer catastrophic brain injury (CBI). There are no standard guidelines for the management of traumatic CBI prior to brain death, and not all trauma centers have institutional CBI guidelines. In addition, there is high variability in management between institutions with guidelines. Catastrophic brain injury guidelines vary and may include various combinations of hormone therapy, vasopressors, fluid resuscitation, and other practices. We hypothesized that centers with CBI guidelines have higher organ donation rates than those without.</p><p><strong>Methods: </strong>This prospective, observational EAST-sponsored multicenter trial included adult (18+ years old) traumatic-mechanism CBI patients at 33 level I and II trauma centers from January 2022 to May 2023. Catastrophic brain injury was defined as a brain injury causing loss of function above the brain stem and subsequent death. Cluster analysis with linear mixed-effects model including UNOS regions and hospital size by bed count was used to determine whether CBI guidelines are associated with organ donation.</p><p><strong>Results: </strong>A total of 790 CBI patients were included in this analysis. In unadjusted comparison, CBI guideline centers had higher rates of organ donation and use of steroids, whole blood, and hormone therapy. In a linear mixed-effects model, CBI guidelines were not associated with organ donation. Registered organ donor status, steroid hormones, and vasopressin were associated with increased relative risk of donation.</p><p><strong>Conclusion: </strong>There is high variability in management of CBI, even at centers with CBI guidelines in place. While the use of institutional CBI guidelines was not associated with increased organ donation, guidelines in this study were not identical. Hormone replacement with steroids and vasopressin was associated with increased donation. Hormone resuscitation is a common feature of CBI guidelines. Further analysis of individual practices that increase organ donation after CBI may allow for more effective guidelines and an overall increase in donation to decrease the long waiting periods for organ transplant recipients.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level II.</p>\",\"PeriodicalId\":17453,\"journal\":{\"name\":\"Journal of Trauma and Acute Care Surgery\",\"volume\":\" \",\"pages\":\"117-126\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Trauma and Acute Care Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TA.0000000000004386\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004386","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Impact of catastrophic brain injury guidelines on organ donation rates: Results of an EAST multicenter trial.
Background: One third of organ donors suffer catastrophic brain injury (CBI). There are no standard guidelines for the management of traumatic CBI prior to brain death, and not all trauma centers have institutional CBI guidelines. In addition, there is high variability in management between institutions with guidelines. Catastrophic brain injury guidelines vary and may include various combinations of hormone therapy, vasopressors, fluid resuscitation, and other practices. We hypothesized that centers with CBI guidelines have higher organ donation rates than those without.
Methods: This prospective, observational EAST-sponsored multicenter trial included adult (18+ years old) traumatic-mechanism CBI patients at 33 level I and II trauma centers from January 2022 to May 2023. Catastrophic brain injury was defined as a brain injury causing loss of function above the brain stem and subsequent death. Cluster analysis with linear mixed-effects model including UNOS regions and hospital size by bed count was used to determine whether CBI guidelines are associated with organ donation.
Results: A total of 790 CBI patients were included in this analysis. In unadjusted comparison, CBI guideline centers had higher rates of organ donation and use of steroids, whole blood, and hormone therapy. In a linear mixed-effects model, CBI guidelines were not associated with organ donation. Registered organ donor status, steroid hormones, and vasopressin were associated with increased relative risk of donation.
Conclusion: There is high variability in management of CBI, even at centers with CBI guidelines in place. While the use of institutional CBI guidelines was not associated with increased organ donation, guidelines in this study were not identical. Hormone replacement with steroids and vasopressin was associated with increased donation. Hormone resuscitation is a common feature of CBI guidelines. Further analysis of individual practices that increase organ donation after CBI may allow for more effective guidelines and an overall increase in donation to decrease the long waiting periods for organ transplant recipients.
Level of evidence: Prognostic and Epidemiological; Level II.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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