Allan B Peetz1, Marie D Kuzemchak2, Jill R Streams3, Mayur B Patel4, Oscar D Guillamondegui3, Bradley M Dennis5, Richard D Betzold6, Oliver L Gunter3, Seth J Karp7, Laura M Beskow8. 1. Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN. Electronic address: allan.b.peetz@vumc.org. 2. Vanderbilt University School of Medicine, Nashville, TN. 3. Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN. 4. Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt Center for Health Services Research, Nashville, TN. 5. Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN. 6. Division of Trauma & Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN. 7. Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt University School of Medicine, Nashville, TN; Surgical Services, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN; Division of Hepatobiliary Surgery & Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN. 8. Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN.
Abstract
BACKGROUND: Trauma patients may present with nonsurvivable injuries, which could be resuscitated for future organ transplantation. Trauma surgeons face an ethical dilemma of deciding whether, when, and how to resuscitate a patient who will not directly benefit from it. As there are no established guidelines to follow, we aimed to describe resuscitation practices for organ transplantation; we hypothesized that resuscitation practices vary regionally. METHOD: Over a 3-month period, we surveyed trauma surgeons practicing in Levels I and II trauma centers within a single state using an instrument to measure resuscitation attitudes and practices for organ preservation. Descriptive statistics were calculated for practice patterns. RESULTS: The survey response rate was 51% (31/60). Many (81%) had experience with resuscitations where the primary goal was to preserve potential for organ transplantation. Many (90%) said they encountered this dilemma at least monthly. All respondents were willing to intubate; most were willing to start vasopressors (94%) and to transfuse blood (84%) (range, 1 unit to >10 units). Of respondents, 29% would resuscitate for ≥24 hours, and 6% would perform a resuscitative thoracotomy. Respect for patients' dying process and future organ quality were the factors most frequently considered very important or important when deciding to stop or forgo resuscitation, followed closely by concerns about excessive resource use. CONCLUSION: Trauma surgeons' regional resuscitation practices vary widely for this patient population. This variation implies a lack of professional consensus regarding initiation and extent of resuscitations in this setting. These data suggest this is a common clinical challenge, which would benefit from further study to determine national variability, areas of equipoise, and features amenable to practice guidelines.
BACKGROUND: Trauma patients may present with nonsurvivable injuries, which could be resuscitated for future organ transplantation. Trauma surgeons face an ethical dilemma of deciding whether, when, and how to resuscitate a patient who will not directly benefit from it. As there are no established guidelines to follow, we aimed to describe resuscitation practices for organ transplantation; we hypothesized that resuscitation practices vary regionally. METHOD: Over a 3-month period, we surveyed trauma surgeons practicing in Levels I and II trauma centers within a single state using an instrument to measure resuscitation attitudes and practices for organ preservation. Descriptive statistics were calculated for practice patterns. RESULTS: The survey response rate was 51% (31/60). Many (81%) had experience with resuscitations where the primary goal was to preserve potential for organ transplantation. Many (90%) said they encountered this dilemma at least monthly. All respondents were willing to intubate; most were willing to start vasopressors (94%) and to transfuse blood (84%) (range, 1 unit to >10 units). Of respondents, 29% would resuscitate for ≥24 hours, and 6% would perform a resuscitative thoracotomy. Respect for patients' dying process and future organ quality were the factors most frequently considered very important or important when deciding to stop or forgo resuscitation, followed closely by concerns about excessive resource use. CONCLUSION: Trauma surgeons' regional resuscitation practices vary widely for this patient population. This variation implies a lack of professional consensus regarding initiation and extent of resuscitations in this setting. These data suggest this is a common clinical challenge, which would benefit from further study to determine national variability, areas of equipoise, and features amenable to practice guidelines.
Authors: Matthias Arlt; Alois Philipp; Sabine Voelkel; Leopold Rupprecht; Thomas Mueller; Michael Hilker; Bernhard M Graf; Christof Schmid Journal: Resuscitation Date: 2010-04-07 Impact factor: 5.262