title: Organ Donation, an Unexpected Benefit of Aggressive Resuscitation of Trauma Patients Presenting Dead on Arrival.
abstract: BACKGROUND
  We sought to determine whether aggressive resuscitation in trauma patients presenting without vital signs, or "dead on arrival," was futile. We also sought to determine whether organ donation was an unexpected benefit of aggressive resuscitation.
  
  
  METHODS
  We conducted a review of adults presenting to our Level I trauma center with no signs of life (pulse = 0 beats/min; systolic blood pressure = 0 mmHg; and no evidence of neurologic activity, Glasgow Coma Scale score = 3). Primary end point was survival to hospital discharge or major organ donation (ie heart, lung, kidney, liver, or pancreas were harvested). We compared our survival rates with those of the National Trauma Data Bank in 2012. Patient demographics, emergency department vital signs, and outcomes were analyzed.
  
  
  RESULTS
  Three hundred and forty patients presented with no signs of life to our emergency department after injury (median Injury Severity Score = 40). There were 7 survivors to discharge, but only 5 (1.5%) were functionally independent (4 were victims of penetrating trauma). Of the 333 nonsurvivors, 12 patients (3.6%) donated major organs (16 kidneys, 2 hearts, 4 livers, and 2 lungs). An analysis of the National Trauma Data Bank yielded a comparable survival rate for those presenting dead on arrival, with an overall survival rate of 1.8% (100 of 5,384); 2.3% for blunt trauma and 1.4% for penetrating trauma.
  
  
  CONCLUSIONS
  Trauma patients presenting dead on arrival rarely (1.5%) achieve functional independence. However, organ donation appears to be an under-recognized outcomes benefit (3.6%) of the resuscitation of injury victims arriving without vital signs.
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX Staten Island University Hospital, Staten Island, NY.
authors.forename: Abdul Q
authors.initials: AQ
authors.lastname: Alarhayem
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Mark T
authors.initials: MT
authors.lastname: Muir
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: James
authors.initials: J
authors.lastname: Fuqua
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Eastridge
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012151:Resuscitation; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement; D014193:Trauma Centers; D055986:Vital Signs; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult