Direct to Operating Room Resuscitation-A Regional Practice Survey

Direct-to-operating room resuscitation (DOR) involves transporting trauma patients directly from the prehospital setting to the operating room (OR), bypassing the emergency department. Although retrospective studies suggest a potential benefit in carefully selected patients, data describing utilization and practice patterns are limited. This study assessed the prevalence of DOR in New England and characterizes regional practice.

A 13-question web-based survey was distributed to trauma medical directors, division chiefs, and program coordinators at all level I and level II trauma centers in New England. Survey items addressed hospital characteristics, DOR utilization, activation criteria, indications, and institutional protocols. The survey was pilot tested for clarity. Descriptive statistics were used for quantitative analysis, and responses were reviewed for common themes.

All 23 queried trauma centers responded (100%). More than half of centers (13/23, 57%) reported performing DOR. At all centers utilizing DOR, activation was at the discretion of the surgeon on call. Most centers lacked predetermined inclusion criteria, standardized activation processes, or procedures for assessment upon arrival to the operation room. Median annual DOR activations were 2 (interquartile range, IQR 1-4), with most centers activating fewer than five times per year (11/13, 85%). Common indications included hemodynamic instability, extremity vascular injury, and unstable interfacility transfer.

DOR is infrequently utilized among New England trauma centers and is largely performed on an ad hoc basis for interfacility transfers without standard protocols. Development of structured activation criteria and in-operating room evaluation processes may improve consistency and optimize patient outcomes. Further investigation is warranted to characterize national practice patterns.