“Predicting Futility in Severely Injured Patients: Using Arrival Lab Values and Physiology to Support Evidence-Based Resource Stewardship”. Van Gent. J Am Col Sur. April 2023.
UT health
Retrospective review of Level 1 pts from 2010-2016 with 9,509 patients
Prior studies:
GCS is poor predictor of mortality (~30% mortality for GCS 3 on arrival)
>10% survival with pH < 7
transfusion number or rate is not a reliable predictor of mortality.
“Death diamond” on TEG (time to max MA < 14min and time to total lysis < 30min has a 94% mortality)
STOP criteria (Suspension of Transfusion and Other Procedures for any of these 100% PPV for mortality)
Arrival SBP < 50 and Ly30 > 30%
Arrival SBP < 50 and Lactate > 15
Arrival SBP < 70, lactate > 15, and Ly30 > 30%
ROSC and Ly30 > 30%
ROSC and Lactate > 12
ROSC and field GCS 3
Author suggestions
Futile for CPR > 10min prior to arrival with blunt trauma
Futile for CPR > 15min prior to arrival with penetrating trauma
99% fatality with no cardiac motion on arrival
Consider a “time out” during resuscitation to eval resources and futility