BACKGROUND: We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS: We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome. RESULTS: A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy. CONCLUSION: Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models. LEVEL OF EVIDENCE: Therapeutic study, level IV; prognostic study, level III.
BACKGROUND: We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study. METHODS: We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome. RESULTS: A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy. CONCLUSION:Cardiac arrest hangingpatients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models. LEVEL OF EVIDENCE: Therapeutic study, level IV; prognostic study, level III.
Authors: C van Walraven; A J Forster; D C Parish; F C Dane; K M Chandra; M D Durham; C Whaley; I Stiell Journal: JAMA Date: 2001-03-28 Impact factor: 56.272
Authors: Sarah M Perman; Anne V Grossestreuer; Douglas J Wiebe; Brendan G Carr; Benjamin S Abella; David F Gaieski Journal: Circulation Date: 2015-11-16 Impact factor: 29.690
Authors: Marion Leary; Anne V Grossestreuer; Stephen Iannacone; Mariana Gonzalez; Frances S Shofer; Clare Povey; Gary Wendell; Susan E Archer; David F Gaieski; Benjamin S Abella Journal: Resuscitation Date: 2012-11-12 Impact factor: 5.262
Authors: Zachary A Matthay; Zane J Hellmann; Rachael A Callcut; Ellicott C Matthay; Brenda Nunez-Garcia; William Duong; Jeffry Nahmias; Aimee K LaRiccia; M Chance Spalding; Satya S Dalavayi; Jessica K Reynolds; Heather Lesch; Yee M Wong; Amanda M Chipman; Rosemary A Kozar; Liz Penaloza; Kaushik Mukherjee; Khaled Taghlabi; Christopher A Guidry; Sirivan S Seng; Asanthi Ratnasekera; Amirreza Motameni; Pascal Udekwu; Kathleen Madden; Sarah A Moore; Jordan Kirsch; Jesse Goddard; James Haan; Kelly Lightwine; Julianne B Ontengco; Daniel C Cullinane; Sarabeth A Spitzer; John C Kubasiak; Joshua Gish; Joshua P Hazelton; Alexandria Z Byskosh; Joseph A Posluszny; Erin E Ross; John J Park; Brittany Robinson; Mary Kathryn Abel; Alexander T Fields; Jonathan H Esensten; Ashok Nambiar; Joanne Moore; Claire Hardman; Pranaya Terse; Xian Luo-Owen; Anquonette Stiles; Brenden Pearce; Kimberly Tann; Khaled Abdul Jawad; Gabriel Ruiz; Lucy Z Kornblith Journal: J Trauma Acute Care Surg Date: 2021-07-01 Impact factor: 3.697
Authors: Richard T Carrick; Jinny G Park; Hannah L McGinnes; Christine Lundquist; Kristen D Brown; W Adam Janes; Benjamin S Wessler; David M Kent Journal: J Am Heart Assoc Date: 2020-08-13 Impact factor: 5.501