Louise de Charentenay1, Guillaume Schnell2, Nicolas Pichon3, Maleka Schenck4, Pierrick Cronier5, Sebastien Perbet6, Jean-Baptiste Lascarrou7, Thomas Rossignol8, Olivier Lesieur9, Laurent Argaud10, Gwenhael Colin11, Bernard Cholley12, Jean-Pierre Quenot13, Hamid Merdji14, Stein Silva15, Michael Piagnerelli16, Jonathan Chelly17, Marie Salvetti1, Segolene Couraud2, Nicolas Deye18, Marc Danguy des Déserts19, Marine Paul1, Guillaume Thiery20, Marc Simon21, Charlotte Martin22, François Vincent23, Vincent Das24, Gwenaelle Jacq1, Frederic Jacobs25, Alexis Soummer26, Julien Mayaux27, Pascal Beuret28, Abdelkader Ouchenir29, Caroline Durant16, Mickael Darmon30, Elie Azoulay30, Bertrand Sauneuf31, Cedric Daubin32, Nicolas Mongardon33, Lucie Biard34, Alain Cariou35, Thomas Geeraerts22, Stephane Legriel36. 1. Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France. 2. Medical-Surgical Intensive Care Unit, GH Le Havre, Le Havre, France. 3. Medical-Surgical Intensive Care Unit, CHU de Limoges, Limoges, France; AfterROSC, Paris, France. 4. Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 5. AfterROSC, Paris, France; Intensive Care Unit, Sud-Francilien Hospital Center, Corbeil-Essonnes, France. 6. Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France. 7. AfterROSC, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medicine Intensive Reanimation, University Hospital, Nantes, France. 8. Medical-Surgical Intensive Care Unit, Centre Hospitalier du Mans, Le Mans, France. 9. AfterROSC, Paris, France; Intensive Care Unit, Saint-Louis Hospital, La Rochelle, France. 10. AfterROSC, Paris, France; Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, Lyon, France. 11. AfterROSC, Paris, France; Medical-Surgical Intensive Care Unit, La Roche-sur-Yon District Hospital Center, La Roche-sur-Yon, France. 12. Service de Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France. 13. Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, France. 14. Service de Médecine Intensive Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Faculté de Médecine and Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA), Strasbourg, France; UMR 1260, Regenerative Nano Medecine, INSERM, Fédération de Médecine, Strasbourg, France. 15. AfterROSC, Paris, France; Réanimation Polyvalente, Hôpital Purpan, CHU Toulouse, Toulouse, France. 16. Intensive Care Unit, Marie-Curie Teaching Hospital, Charleroi, Belgium. 17. AfterROSC, Paris, France; Intensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, France. 18. AfterROSC, Paris, France; Medical Intensive Care Unit, Lariboisière Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 19. Clermont Tonnerre Military Hospital, Brest, France. 20. Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Etienne, France. 21. Intensive Care Department, Cliniques du Sud-Luxembourg of Arlon, Arlon, Belgium. 22. Anesthésie Réanimation, Hôpital Purpan, CHU Toulouse, Toulouse, France. 23. Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France. 24. Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France. 25. Medical Intensive Care Unit, Beclere Teaching Hospital, Clamart, France. 26. Department of Intensive Care Medecine, Foch Hospital, Suresnes, France. 27. Department of Pneumology and Intensive Care, Pitie Salpetriere Teaching Hospital, Paris, France. 28. Department of Intensive and Continuous Care, Roanne Hospital, Roanne, France. 29. Medical Intensive Care Unit, Louis Pasteur Hospital, Chartres, France. 30. Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 31. AfterROSC, Paris, France; General Intensive Care Unit, Cotentin Public Hospital Center, Cherbourg-en-Cotentin, France. 32. AfterROSC, Paris, France; Medical Intensive Care Unit, Caen Teaching Hospital, Caen, France. 33. AfterROSC, Paris, France; Department of Anesthesiology and Surgical Intensive Care Units, Henri Mondor Teaching Hospital, Créteil, France. 34. Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint Louis, Paris, France; Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation Assessments (ECSTRRA) Team, INSERM U1153 CRESS, Paris, France. 35. AfterROSC, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medical Intensive Care Unit, Cochin Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 36. Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France; AfterROSC, Paris, France; Team PsyDev, CESP, INSERM, UVSQ, University Paris-Saclay, Villejuif, France. Electronic address: slegriel@ch-versailles.fr.
Abstract
BACKGROUND: Near-hanging experiences are life-threatening events about which few data are available. RESEARCH QUESTION: What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience? STUDY DESIGN AND METHODS: Adult patients who were resuscitated successfully after suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Patients were identified by searching the hospital databases for International Statistical Classification of Diseases and Related Health Problems, 9th and 10th revisions, codes and hospital charts for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary end points. Secondary outcomes were evaluation of temporal trends and identification of predictors of hospital mortality. RESULTS: Of the 886 patients (181 women and 705 men; median age, 43 years; interquartile range, 34-52 years), 266 (30.0%) had attempted suicide previously, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalized. Median time from hanging awareness to unhanging was 0 min (interquartile range [IQR], 0-0; range, 0-82 min). Median Glasgow Coma Scale score was 3 (IQR, 3-5) at ICU admission. Hanging induced cardiac arrest in 450 of 886 patients (50.8%). Overall, 497 of 886 patients (56.1%) were alive at hospital discharge, including 479 of 497 patients (96.4%) with a favorable neurocognitive outcome (defined as a Glasgow Outcome Scale score of 4 or 5). By multivariate analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95% CI, 7.21-60.90; P < .00001) and findings at ICU admission of glycemia level > 1.4 g/L (OR, 4.34; 95% CI, 1.82-10.81; P = .0007) and of lactate level > 3.5 mmol/L (OR, 9.98; 95% CI, 4.17-25.36; P < .00001). INTERPRETATION: The findings from this large multicenter retrospective cohort emphasize the very high mortality after hanging injury chiefly because of hanging-induced cardiac arrest. However, patients who survive near-hanging experiences achieve excellent neurocognitive recovery. Studies of early neuroprotective strategies for patients who have undergone near-hanging experiences are warranted. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov.
BACKGROUND: Near-hanging experiences are life-threatening events about which few data are available. RESEARCH QUESTION: What are the outcomes and early predictors of hospital mortality in critically illpatients who have undergone a near-hanging experience? STUDY DESIGN AND METHODS: Adult patients who were resuscitated successfully after suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Patients were identified by searching the hospital databases for International Statistical Classification of Diseases and Related Health Problems, 9th and 10th revisions, codes and hospital charts for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary end points. Secondary outcomes were evaluation of temporal trends and identification of predictors of hospital mortality. RESULTS: Of the 886 patients (181 women and 705 men; median age, 43 years; interquartile range, 34-52 years), 266 (30.0%) had attempted suicide previously, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalized. Median time from hanging awareness to unhanging was 0 min (interquartile range [IQR], 0-0; range, 0-82 min). Median Glasgow Coma Scale score was 3 (IQR, 3-5) at ICU admission. Hanging induced cardiac arrest in 450 of 886 patients (50.8%). Overall, 497 of 886 patients (56.1%) were alive at hospital discharge, including 479 of 497 patients (96.4%) with a favorable neurocognitive outcome (defined as a Glasgow Outcome Scale score of 4 or 5). By multivariate analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95% CI, 7.21-60.90; P < .00001) and findings at ICU admission of glycemia level > 1.4 g/L (OR, 4.34; 95% CI, 1.82-10.81; P = .0007) and of lactate level > 3.5 mmol/L (OR, 9.98; 95% CI, 4.17-25.36; P < .00001). INTERPRETATION: The findings from this large multicenter retrospective cohort emphasize the very high mortality after hanging injury chiefly because of hanging-induced cardiac arrest. However, patients who survive near-hanging experiences achieve excellent neurocognitive recovery. Studies of early neuroprotective strategies for patients who have undergone near-hanging experiences are warranted. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov.