A small modeling study indicates that some patients with severe traumatic brain injury (TBI) might have recovered if they had been kept on life support longer.
The decision to withdraw life support from patients with severe TBI should not be made prematurely, according to a new study. Life support for these patients is sometimes withdrawn too early, potentially missing the chance for recovery. Nearly 200 Americans die from TBI daily, often due to falls, firearm-related injuries, or car crashes.
Severe TBI patients face a high risk of death or long-term disabilities affecting physical and cognitive abilities. These patients may require life support in an ICU, including ventilators and medication to reduce fluid build-up. However, if doctors believe recovery is unlikely, life support may be withdrawn.
The American College of Surgeons recommends “full treatment” for at least 72 hours for severe TBI patients in the ICU. However, there are no clinical guidelines in the U.S. on when or which patients should have life support withdrawn.
“We know that prognosis, or determining how somebody is going to recover after a severe traumatic brain injury, is incredibly imprecise,” said co-senior study author Yelena Bodien, an assistant professor in neurology at Massachusetts General Hospital. Clinicians must predict within days of the injury whether a patient will die, develop a long-term disability, or recover significantly, often without standardized guidelines. These predictions are then shared with the patient’s caregivers and loved ones, who decide whether to withdraw life support.
Published on May 13 in the *Journal of Neurotrauma*, the study suggests that life support might sometimes be withdrawn when patients still have a chance of recovery. Researchers analyzed data from about 3,100 severe TBI patients seen in 18 U.S. trauma centers within 24 hours of their injuries. They identified 90 patients who died around five days after being taken off a ventilator and matched them to 80 patients with similar characteristics who continued to receive other life support forms.
Among the 80 patients kept on life support, 55% died within six months of their injuries. However, over 30% of the survivors regained some independence in daily activities within that timeframe. The researchers argue that delaying the decision to withdraw life support could benefit some TBI patients.
Considering the uncertainty around severe TBI prognosis, clinicians should be cautious about early withdrawal of life support, and families should feel empowered to request delaying such decisions, Bodien said.
Dr. Zachary Hickman, a neurosurgeon at Mount Sinai Health System, noted that the study provides the best data so far on this topic, highlighting the difficulty of predicting long-term outcomes after severe TBI. Dr. Christos Lazaridis, a neurocritical care professor at the University of Chicago, emphasized the significant uncertainty in decisions about life-sustaining measures for patients with severe brain injury.
Future research could improve clinicians’ predictions about patients’ chances of recovery, providing better guidance for families and caregivers.
