Patient 6 was a 71-year-old male pedestrian struck by a vehicle with reported field GCS = 14. The patient was intubated for airway compromise, and arrived at the trauma center with presentation GCS = 3T5. His primary survey revealed polytrauma with gross limb deformities and signs of craniofacial injury. A Focused Assessment with Sonography for Trauma examination was negative; CT of the head revealed diffuse traumatic SAH and a small falcine subdural hematoma. He was found to have coagulopathy by admission laboratory evaluation. After resuscitation and correction of coagulopathy, the patient was admitted to neurocritical care and an ICP monitor was placed. Repeat cranial imaging demonstrated worsening bifrontal contusions and an enlarging left temporal contusion. The patient's neurologic examination declined to GCS = 3T despite aggressive medical management for refractory ICP. A family discussion was held on day 2, at which time a DNR-CC order was activated. The patient was terminally extubated. The end-of-life recordings are shown in Figure C.
Patient 5 was a 47-year-old male occupant of a car struck by a train with reported field Glasgow Coma Scale (GCS) = 3. The patient was intubated for airway protection and arrived at the trauma center with presentation GCS = 3T. Bilateral chest tubes were placed for traumatic pneumothoraces. Once stabilized, the patient had a postresuscitation GCS = 1T3. CT of the head demonstrated skull vault fractures, diffuse traumatic SAH, subdural hematoma, and diffuse petechial shear injuries. He was admitted to neurocritical care, and an ICP monitor was placed with elevated ICP noted. A family discussion was held on day 2, a DNR-CC order was activated, and the patient was terminally extubated. Similar to Patients 2 and 4, nonspreading depression occurred while ptiO2 showed the final drop. The terminal SD started 73 seconds after nonspreading depression had rendered the ECoG isoelectric (Fig A, B).