Impact of catastrophic brain injury guidelines on donor management goals at a level I trauma center

Background: An organ procurement organization (OPO) and a level I trauma center developed catastrophic brain injury guidelines (CBIGs) to assist in the care of severely brain-injured adult patients before brain death. The CBIGs provided a set of clinical guidelines to maintain patient stability and optimize opportunity for organ donation.

Objective: The aim of this study was to determine if the use of the CBIGs affected the OPO's ability to achieve donor management goals (DMGs) before organ recovery.

Methods: We conducted a retrospective analysis comparing the number of DMGs met in the hospital's donors before and after the CBIGs were used. The analysis included 133 cases; 67 donors in the pre-CBIG data and 66 donors in the post-CBIG review. Donor management goals measured included: systolic blood pressure >100 mm Hg; 1 pressor ≤10 μg/kg/min; urine output 1-2 mL/kg/h; pO(2) >100 mm Hg; Na <160 meq/L; pH within normal limits (7.35-7.45); temperature 36.5-37.5°C; arterial line in place and central line in place with monitor.

Results: After the introduction of the CBIGs, 78% of DMGs were met more often, with 1 goal (Na) remaining equivalent and 2 goals (pO(2) and pH) met less often. Increase in achievement of individual DMGs ranged from 4% to 33%. The pre-CBIG cases averaged 2.90 missed goals per donor compared with an average of 1.79 in the post-CBIG data. Only 5 pre-CBIG donors (7%) achieved all of the DMGs. That figure rose to 12 donors (18%) in the post-CBIG data.

Conclusions: While other factors may have contributed to our results, we think that there is a positive relationship between the CBIGs and the increase in meeting most DMGs. As we refine our donor management, we will focus on the factors we met less successfully. Ultimately, the use of the CBIGs before brain death led to more stable donors, maximizing transplantable organs.