Brief Review of Guidelines for Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations— Hawryluk 2020

This is a brief audio review. In the article Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations by Hawryluk and Colleagues, The outcomes and key points are as noted: Rescue I-C-P Trial and DECRA Trial data were incorporated in to the 2020 guidelines. They summary/key points are listed: 1. Treatment of increased intracranial pressure is critical to treatment of severe traumatic brain injury. 2. Decompressive craniectomy 3. DECRA trial examined early severe T-B-I patients 4. Rescue I-C-P trial examined late severe T-B-I patients. 5. Secondary decompressive craniectomy is recommended for late refractory elevated intracranial pressure due to improvement in mortality and favorable outcomes. 6. Secondary decompressive craniectomy is not recommended for early refractory elevated intracranial pressure. 7. For severe traumatic brain injury, a large frontotemporoparietal decompressive craniectomy, at least 12x15x15 cm is recommended for severe Traumatic brain injury due to improvement in mortality and neurological outcome. 8. Secondary decompressive craniectomy may be effective in lowering intracranial pressure and intensive care unit stay length.

Hawryluk GWJ, Rubiano AM, Totten AM, O'Reilly C, Ullman JS, Bratton SL, Chesnut R, Harris OA, Kissoon N, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Lumba-Brown A, Ghajar J. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurgery. 2020 Sep 1;87(3):427-434. doi: 10.1093/neuros/nyaa278. PMID: 32761068; PMCID: PMC7426189.