• Tanya L Zakrison, Rachael Essig, Ann Polcari, William McKinley, Damon Arnold, Robel Beyene, Kenneth Wilson, Selwyn Rogers, Jeffrey B Matthews, J Michael Millis, Peter Angelos, Michael O'Connor, Ali Mansour, Fernando Goldenberg, Thomas Spiegel, Peleg Horowitz, Paramita Das, Mark Slidell, Nikunj Chokshi, Iheoma Okeke, Rolf Barth, Harry E Wilkins, Tareq Kass-Hout, and Christos Lazaridis.
• Department of Surgery, University of Chicago, Chicago, IL.
• Ann. Surg. 2023 Jan 1; 277 (1): 667266-72.

ObjectiveThe aim of this review was to review the ethical and multidisciplinary clinical challenges facing trauma surgeons when resuscitating patients presenting with penetrating brain injury (PBI) and multicavitary trauma.BackgroundWhile there is a significant gap in the literature on managing PBI in patients presenting with multisystem trauma, recent data demonstrate that resuscitation and prognostic features for such patients remains poorly described, with trauma guidelines out of date in this field.MethodsWe reviewed a combination of recent multidisciplinary evidence-informed guidelines for PBI and coupled this with expert opinion from trauma, neurosurgery, neurocritical care, pediatric and transplant surgery, surgical ethics and importantly our community partners.ResultsTraditional prognostic signs utilized in traumatic brain injury may not be applicable to PBI with a multidisciplinary team approach suggested on a case-by-case basis. Even with no role for neurosurgical intervention, neurocritical care, and neurointerventional support may be warranted, in parallel to multicavitary operative intervention. Special considerations should be afforded for pediatric PBI. Ethical considerations center on providing the patient with the best chance of survival. Consideration of organ donation should be considered as part of the continuum of patient, proxy and family-centric support and care. Community input is crucial in guiding decision making or protocol establishment on an institutional level.ConclusionsSupport of the patient after multicavitary PBI can be complex and is best addressed in a multidisciplinary fashion with extensive community involvement.Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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