1556: GUNSHOT WOUNDS AND NONSURVIVABLE BRAIN INJURY: PREDICTORS AND BARRIERS OF SUCCESSFUL ORGAN DONATION

Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain. The data were analyzed for demographics, change in international normalized ratio (INR), and subsequent organ donation. The primary end point was organ donation. Eighty-eight patients with lethal traumatic brain injury were identified from the trauma registry of whom 13 were coagulopathic at the time of admission (mean INR 2.2 ± 0.8). Of these 13 patients, 10 patients received PCC in an effort to reverse their coagulopathy. Mean INR before PCC administration was 2.01 ± 0.7 and 1.1 ± 0.7 after administration ( P < 0.006). Correction of coagulopathy was attained in 70 per cent (seven of 10) patients. Of these seven patients, consent for donation was obtained in six patients and resulted in 19 solid organs being procured. The cost of PCC per patient was $1022 ± 544. PCC effectively reveres coagulopathy associated with lethal traumatic brain injury and enabled patients to proceed to organ donation. Although various methodologies exist for the treatment of coagulopathy to facilitate organ donation, PCC provides a rapid and cost-effective therapy for reversal of coagulopathy in patients with lethal traumatic brain injuries.

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End-of-life practices in patients with devastating brain injury in Spain: Implications for organ donation

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2017.03.003 ◽

2017 ◽

Vol 41 (3) ◽

pp. 162-173

Author(s):

B. Domínguez-Gil ◽

E. Coll ◽

T. Pont ◽

M. Lebrón ◽

E. Miñambres ◽

...

Keyword(s):

Brain Injury ◽

Organ Donation ◽

End Of Life

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Characterization of 95 patients with traumatic brain injury due to gunshot wounds at a referral centre in Cali, Colombia

Neurocirugía (English Edition) ◽

10.1016/j.neucie.2018.07.002 ◽

2018 ◽

Vol 29 (5) ◽

pp. 217-224

Author(s):

Daniel Ospina-Delgado ◽

Laura Marcela Mosquera Salas ◽

Alejandro Enríquez-Marulanda ◽

Jaime Hernández-Morales ◽

Robinson Pacheco ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Gunshot Wounds ◽

Referral Centre

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Penetrating Bihemispheric Traumatic Brain Injury: A Collective Review of Gunshot Wounds to the Head

World Neurosurgery ◽

10.1016/j.wneu.2017.05.068 ◽

2017 ◽

Vol 104 ◽

pp. 653-659 ◽

Cited By ~ 18

Author(s):

Lauren Turco ◽

David L. Cornell ◽

Bradley Phillips

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Gunshot Wounds

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Creatine kinase isoenzymes in acute brain injury

Journal of Neurosurgery ◽

10.3171/jns.1981.55.4.0511 ◽

1981 ◽

Vol 55 (4) ◽

pp. 511-515 ◽

Cited By ~ 30

Author(s):

Markku Kaste ◽

Juha Hernesniemi ◽

Hannu Somer ◽

Matti Hillbom ◽

Aarne Konttinen

Keyword(s):

Creatine Kinase ◽

Brain Injury ◽

Prognostic Significance ◽

Myocardial Damage ◽

Gunshot Wounds ◽

Acute Brain Injury ◽

Peak Activity ◽

Content Type ◽

T Wave ◽

Fine Print

✓ Brain-type creatine kinase (CK) isoenzyme (CK-BB) was detected in the serum in 13 out of 26 patients with acute brain injury (50%). The peak of CK-BB activity ranged from 5 to 188 U/liter, constituting, on average, 10.5% of the total CK activity. The highest activities were seen in patients with gunshot wounds. High CK-BB activity was associated with poor prognosis, but minimal CK-BB elevations did not have prognostic significance. Heart-type creatine kinase isoenzyme (CK-MB) was detected in the serum in 17 out of 26 patients (65%). The peak activity ranged from 5 to 115 U/liter, constituting, on average, 6.6% of total CK activity. Electrocardiograms taken from 20 patients revealed transient T-wave inversions in the precordial leads in four patients; three of them also showed serum CK-MB activity. Subendocardial hemorrhage was detected at autopsy in three of the five CK-MB-positive patients, but in none of the four CK-MB-negative cases. Present findings suggest that acute brain injury may secondarily cause myocardial damage.

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Human Lung Cell Pyroptosis Following Traumatic Brain Injury

Cells ◽

10.3390/cells8010069 ◽

2019 ◽

Vol 8 (1) ◽

pp. 69 ◽

Cited By ~ 4

Author(s):

Nadine Kerr ◽

Juan de Rivero Vaccari ◽

Oliver Umland ◽

M. Bullock ◽

Gregory Conner ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Endothelial Cell ◽

Brain Injury ◽

Lung Injury ◽

Critical Role ◽

Gunshot Wounds ◽

Extracellular Vesicle ◽

Inflammasome Activation ◽

Trauma Patients ◽

Severe Tbi

Approximately 30% of traumatic brain injured patients suffer from acute lung injury or acute respiratory distress syndrome. Our previous work revealed that extracellular vesicle (EV)-mediated inflammasome signaling plays a crucial role in the pathophysiology of traumatic brain injury (TBI)-induced lung injury. Here, serum-derived EVs from severe TBI patients were analyzed for particle size, concentration, origin, and levels of the inflammasome component, an apoptosis-associated speck-like protein containing a caspase-recruiting domain (ASC). Serum ASC levels were analyzed from EV obtained from patients that presented lung injury after TBI and compared them to EV obtained from patients that did not show any signs of lung injury. EVs were co-cultured with lung human microvascular endothelial cells (HMVEC-L) to evaluate inflammasome activation and endothelial cell pyroptosis. TBI patients had a significant increase in the number of serum-derived EVs and levels of ASC. Severe TBI patients with lung injury had a significantly higher level of ASC in serum and serum-derived EVs compared to individuals without lung injury. Only EVs isolated from head trauma patients with gunshot wounds were of neural origin. Delivery of serum-derived EVs to HMVEC-L activated the inflammasome and resulted in endothelial cell pyroptosis. Thus, serum-derived EVs and inflammasome proteins play a critical role in the pathogenesis of TBI-induced lung injury, supporting activation of an EV-mediated neural-respiratory inflammasome axis in TBI-induced lung injury.

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Ethical controversies at end of life after traumatic brain injury: Defining death and organ donation

Critical Care Medicine ◽

10.1097/ccm.0b013e3181ec5354 ◽

2010 ◽

Vol 38 ◽

pp. S502-S509 ◽

Cited By ~ 21

Author(s):

Michael Souter ◽

Gail Van Norman

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Organ Donation ◽

End Of Life ◽

Defining Death

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The donor potential of twenty six donor bases in the Russian Federation: external audit (a pilot project)

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2020-48-024 ◽

2020 ◽

Vol 48 (3) ◽

pp. 153-161

Author(s):

V. L. Vinogradov ◽

K. K. Gubarev ◽

A. I. Zakhlevnyy ◽

D. S. Svetlakova

Keyword(s):

Intensive Care ◽

Brain Injury ◽

Brain Death ◽

Organ Donation ◽

Intensive Care Units ◽

Pilot Project ◽

Secondary Brain Injury ◽

External Audit ◽

Potential Donor ◽

Donation Process

Rationale: The imbalance between the need for donor organs and their current availability is a growing problem for all countries. An assessment of potential donor numbers is considered to be an important step towards better understanding of the problem as a whole at the national scale. This would help to build up a concept of a successful strategy to resolve this inequity.Aim: To analyze the use of external audit of the efficacy of identification of potential organ donors with confirmed brain death.Materials and methods: As a part of a pilot project aimed to increase the efficacy of donor bases of the Russian Federal Medical Biological Agency (FMBA), we retrospectively analyzed 5932 medical files of patients who died from 2014 to 2018 in the departments of resuscitation and intensive care units of 26 medical establishments serving as a donor bases in Moscow, Orenburg, Saratov, Abakan, Stavropol and FMBA of Russia. The probability of brain death was assessed with a special QAPDD (Quality Assurance Program in the Deceased Donation Process) technique focused on organ donation after brain death which is used for external audit in Spanish hospitals.Results: Clinical manifestation of brain death were identified in 20.3% (95% confidence interval (CI) 18.4–22.4) of the patients aged 18 to 65 years with severe primary and secondary brain injury who died in the departments of resuscitation and had been maintained on mechanical ventilation at least 12 hours until their death was confirmed. The rate of potential donor identification with clinical manifestations of brain death in the donating in-patient departments was 12% (95% CI 10.5–13.7) of those who died with severe primary and secondary brain injury. The external audit performed in 26 donating in-patient departments, has shown that 41% (95% CI 35.8–46.4) of potential donors with brain death were not identified.Conclusion: With the use of the QAPDD technique in our study, we found that 41% of potential donors were not identified in the Russian in-patient clinics participating in organ donation. Based on the information obtained during the audit of medical files in intensive care units, we can make realistic conclusions on the current system of organ donation, identify potential pitfalls in the identification procedures of potential donors, increase the efficacy of donation process, and to improve the system as a whole. The process could become effective only through the activities of specially trained donor hospital transplant coordinators.

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Unusual Penetrating Cranioencephalic Injury by a Harpoon in a Brazilian Man

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v23i4.1233 ◽

2018 ◽

Vol 23 (4) ◽

pp. 342-345

Author(s):

Sérgio Robson Martucci Júnior ◽

Moyses Isaac Cohen ◽

Renato Andrade Chaves ◽

Marco Aurélio Fernandes Teixeira ◽

Richam Faissal El Hossain Ellakkis ◽

...

Keyword(s):

Patient Outcome ◽

Brain Injury ◽

Functional Outcome ◽

Head Trauma ◽

Therapeutic Approach ◽

Present Report ◽

Gunshot Wounds ◽

Low Energy ◽

Review Of The Literature ◽

Penetrating Brain Injury

Penetrating brain injury due to low energy objects is an unusual cause of head trauma, unlike gunshot wounds. Most cases reported are noteworthy due to its large dimension and, sometimes, good functional outcome. The present report describes the case of a Brazilian man presenting with a deep penetrating brain injury by a harpoon and no neurologic deficits. We discuss the main mechanisms of trauma and make a brief review of the literature upon epidemiological aspects and possible therapeutic approach. The early and appropriate neurosurgical management, on experience hands, may improve considerably patient outcome.

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Inflammatory Signalling Associated with Brain Dead Organ Donation: From Brain Injury to Brain Stem Death and Posttransplant Ischaemia Reperfusion Injury

Journal of Transplantation ◽

10.1155/2013/521369 ◽

2013 ◽

Vol 2013 ◽

pp. 1-19 ◽

Cited By ~ 33

Author(s):

Ryan P. Watts ◽

Ogilvie Thom ◽

John F. Fraser

Keyword(s):

Brain Injury ◽

Brain Death ◽

Organ Donation ◽

Reperfusion Injury ◽

Inflammatory Mediators ◽

Ischaemia Reperfusion Injury ◽

Donor Pool ◽

Ongoing Research ◽

Ischaemia Reperfusion ◽

Brain Dead

Brain death is associated with dramatic and serious pathophysiologic changes that adversely affect both the quantity and quality of organs available for transplant. To fully optimise the donor pool necessitates a more complete understanding of the underlying pathophysiology of organ dysfunction associated with transplantation. These injurious processes are initially triggered by catastrophic brain injury and are further enhanced during both brain death and graft transplantation. The activated inflammatory systems then contribute to graft dysfunction in the recipient. Inflammatory mediators drive this process in concert with the innate and adaptive immune systems. Activation of deleterious immunological pathways in organ grafts occurs, priming them for further inflammation after engraftment. Finally, posttransplantation ischaemia reperfusion injury leads to further generation of inflammatory mediators and consequent activation of the recipient’s immune system. Ongoing research has identified key mediators that contribute to the inflammatory milieu inherent in brain dead organ donation. This has seen the development of novel therapies that directly target the inflammatory cascade.

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