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April 8, 2013

Brain Injury & Food

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Could increased stomach feeding of patients with brain injuries increase their chances of survival? "Yes," says one study just out, and neurosurgeons are responding to the results by literally rewriting the book on brain trauma.

[If you cannot see the Revver video below, you can click here for a high quality mp4 video.]

Interviewees: Roger Hartl, Weill Cornell Medical College; John Turco, Survived brain trauma
Produced by Sunita Reed — Edited by Sunita Reed and James Eagan
Copyright © ScienCentral, Inc., with additional footage courtesy American Stroke Association and ABC News.

Nutrition Predicts Survival

Not many people have a model of their own skull showing a large section missing.

"It's scary when you look at it — oof," says John Turco as he holds his model.

But not many people survive gunshots to the head and face like John Turco suffered in a dispute in 2005 in New York City. Turco's neurosurgeon, Weill Cornell Medical College's Roger Hartl, says a major factor in Turco's survival was likely how soon he got adequate nutrition through a stomach feeding tube while in a coma.

Hartl explains, "We have always tried to provide nutrition to these patients but what we have not known in the past was that it is very, very important to do this early on within the first day or two days after trauma and to do this very aggressively."

Hartl discovered this by analyzing the results of 797 comatose brain trauma patients treated at 21 trauma centers in New York over six years. He found that patients who did not get fed within five or seven days were two-fold and four-fold more likely to die in the two week period following initial trauma.

Hartl says that while doctors do order feeding tubes for brain-trauma patients, at first they're often more focused on other urgent issues like surgery, brain swelling and blood pressure. Also, patients can have trouble tolerating being fed through a nasogastric tube.

Current guidelines in the widely used handbook, Guidelines for Management of Severe Traumatic Brain Injury, recommend that patients receive 100-percent of calorie requirements within a week, but Hartl's latest study overturns that. He wrote in the Journal of Neurosurgery that immediate feeding is one simple way to greatly decrease the risk of death.

Hartl also found there's no upper limit for the amount of calories, but that less than needed has a dire effect. For example, a man Turco's size needs about eight cans of the standard nutritional supplement — or about 2000 calories per day. The study showed that removing just three of those cans increases patient mortality by 35-percent.

Hartl, who is a co-author of the traumatic brain injury handbook, says current guidelines were based on some small studies that represented the best data available. The study he conducted is the largest to date of nutritional care and survival outcome. Hartl plans to change the guidelines in the next edition of the handbook.

Hartl explains that many factors are hard for doctors to control, like blood pressure and brain swelling. But the results of his study now show that nutrition is one important factors that is easily controllable.

He says, "It's done very easily. It doesn't require any magic bullet or any drug or any kind of new technology. It's just basically putting a feeding tube in and feeding these patients aggressively early on."

Hartl says that Turco's excellent recovery from such a severe head trauma is not very common and also credits non-medical factors, like Turco's strong personality, to his survival.

Turco is indeed resilient. He recalls the circumstances of the tragic day — February 4, 2005. He was on Madison Avenue with his fiancee Inessa Ivanov. Her ex-husband, Vadim Ivanov, confronted them and shot Turco. Ivanov then shot and killed his ex-wife and killed himself. Turco says softly, "I loved her. She was beautiful on the inside and outside."

Turco's sister, Catherine Schneck and her husband, Harold Schneck, were with him every day through his slow recovery that required multiple surgeries. Turco says he would not be alive if it weren't for their care, love and encouragement. Today they are visiting him in his Forest Hills apartment. They talk happily about their children, his two children, his four grandchildren and Inessa's son Nicolas Ivanov, who came to live with Turco after his mother died. Turco plays the guitar and sings for his sister. Laughter fills the room.

When asked how he manages to be so positive Turco says, "Life makes me happy. I just love life. I love life because look at what life, even with all the tragedy that I've gone through, look at what it's brought me."

PUBLICATION: Journal of Neurosurgery, July 2008

AUTHORS: Roger Hartl, Linda M. Gerber, Quanhong Ni and Jamshid Ghajar

RESEARCH FUNDED BY: A New York State Department of Health contract to the Brain Trauma Foundation

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