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Salvetti M, Schnell G, Pichon N, Schenck M, Cronier P, Perbet S, Lascarrou JB, Guitton C, Lesieur O, Argaud L, Colin G, Cholley B, Quenot JP, Merdji H, Geeraerts T, Piagnerelli M, Jacq G, Paul M, Chelly J, de Charentenay L, Deye N, Danguy des Déserts M, Thiery G, Simon M, Das V, Jacobs F, Cerf C, Mayaux J, Beuret P, Ouchenir A, Lafarge A, Sauneuf B, Daubin C, Cariou A, Silva S, Legriel S. Epidemiology and outcome predictors in 450 patients with hanging-induced cardiac arrest: a retrospective study. Front Neurol 2023; 14:1240383. [PMID: 37818219 PMCID: PMC10560712 DOI: 10.3389/fneur.2023.1240383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 10/12/2023] Open
Abstract
Background Cardiac arrest is the most life-threatening complication of attempted suicide by hanging. However, data are scarce on its characteristics and outcome predictors. Methods This retrospective observational multicentre study in 31 hospitals included consecutive adults admitted after cardiac arrest induced by suicidal hanging. Factors associated with in-hospital mortality were identified by multivariate logistic regression with multiple imputations for missing data and adjusted to the temporal trends over the study period. Results Of 450 patients (350 men, median age, 43 [34-52] years), 305 (68%) had a psychiatric history, and 31 (6.9%) attempted hanging while hospitalized. The median time from unhanging to cardiopulmonary resuscitation was 0 [0-5] min, and the median time to return of spontaneous circulation (ROSC) was 20 [10-30] min. Seventy-nine (18%) patients survived to hospital discharge. Three variables were independently associated with higher in-hospital mortality: time from collapse or unhanging to ROSC>20 min (odds ratio [OR], 4.71; 95% confidence intervals [95%CIs], 2.02-10.96; p = 0.0004); glycaemia >1.4 g/L at admission (OR, 6.38; 95%CI, 2.60-15.66; p < 0.0001); and lactate >3.5 mmol/L at admission (OR, 6.08; 95%CI, 1.71-21.06; p = 0.005). A Glasgow Coma Scale (GCS) score of >5 at admission was associated with lower in-hospital mortality (OR, 0.009; 95%CI, 0.02-0.37; p = 0.0009). Conclusion In patients with hanging-induced cardiac arrest, time from collapse or unhanging to return of spontaneous circulation, glycaemia, arterial lactate, and coma depth at admission were independently associated with survival to hospital discharge. Knowledge of these risk factors may help guide treatment decisions in these patients at high risk of hospital mortality.
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Affiliation(s)
- Marie Salvetti
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles—Site André Mignot, Le Chesnay, France
| | | | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, CHU de Limoges, Limoges, France
- AfterROSC, Paris, France
| | - Maleka Schenck
- Médecine Intensive Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierrick Cronier
- AfterROSC, Paris, France
- Intensive Care Unit, Sud-Francilien Hospital Center, Corbeil-Essonnes, France
| | - Sebastien Perbet
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, 58 Rue Montalembert, Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | | | - Christophe Guitton
- Medical-Surgical Intensive Care Unit, Centre Hospitalier du Mans, Le Mans, France
| | - Olivier Lesieur
- AfterROSC, Paris, France
- Intensive Care Unit, Saint-Louis Hospital, La Rochelle, France
| | - Laurent Argaud
- AfterROSC, Paris, France
- Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, Lyon, France
| | - Gwenhael Colin
- AfterROSC, Paris, France
- Medical-Surgical Intensive Care Unit, La Roche-sur-Yon District Hospital Centre, La Roche-sur-Yon, France
| | - Bernard Cholley
- Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Cité et Service d'Anesthésie-Réanimation Médecine Péri Opératoire, Paris, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, Dijon, France
| | - Hamid Merdji
- Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive Réanimation, Université de Strasbourg (UNISTRA), Strasbourg, France
- UMR 1260, Regenerative Nano Medicine, INSERM, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Thomas Geeraerts
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Toulouse University Hospital, Toulouse, France
| | - Michael Piagnerelli
- Intensive Care Unit, Marie-Curie Teaching Hospital, Université Libre de Bruxelles, Charleroi, Belgium
| | - Gwenaelle Jacq
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles—Site André Mignot, Le Chesnay, France
| | - Marine Paul
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles—Site André Mignot, Le Chesnay, France
| | - Jonathan Chelly
- AfterROSC, Paris, France
- Intensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Louise de Charentenay
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles—Site André Mignot, Le Chesnay, France
| | - Nicolas Deye
- AfterROSC, Paris, France
- Medical Intensive Care Unit, Lariboisière University Hospital, APHP, Paris, France
- INSERM UMR-S 942, Lariboisière Hospital, Paris, France
| | | | - Guillaume Thiery
- Medical-Surgical Intensive Care Unit, Saint-Étienne University Hospital, Saint-Étienne, France
| | - Marc Simon
- Department of Intensive Care, Cliniques du Sud-Luxembourg of Arlon, Arlon, Belgium
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Frederic Jacobs
- Medical Intensive Care Unit, Beclère Teaching Hospital, Clamart, France
| | - Charles Cerf
- Department of Intensive Care, Foch Hospital, Suresnes, France
| | - Julien Mayaux
- Department of Pulmonology and Intensive Care, Pitié-Salpêtrière Teaching Hospital, Paris, France
| | - Pascal Beuret
- Department of Intensive and Continuous Care, Roanne Hospital, Roanne, France
| | | | - Antoine Lafarge
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bertrand Sauneuf
- AfterROSC, Paris, France
- General Intensive Care Unit, Cotentin Public Hospital Centre, Cherbourg-en-Cotentin, France
| | - Cedric Daubin
- AfterROSC, Paris, France
- Medical Intensive Care Unit, Caen Teaching Hospital, Caen, France
| | - Alain Cariou
- AfterROSC, Paris, France
- Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris and Université de Paris, Paris, France
- INSERM U970, Paris Cardiovascular Research Centre, Paris, France
| | - Stein Silva
- AfterROSC, Paris, France
- Critical Care Unit, University Teaching Hospital of Purpan, Toulouse, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles—Site André Mignot, Le Chesnay, France
- AfterROSC, Paris, France
- UVSQ, INSERM, CESP, PsyDev Team, Paris-Saclay University, Villejuif, France
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de Charentenay L, Schnell G, Pichon N, Schenck M, Cronier P, Perbet S, Lascarrou JB, Rossignol T, Lesieur O, Argaud L, Colin G, Cholley B, Quenot JP, Merdji H, Silva S, Piagnerelli M, Chelly J, Salvetti M, Couraud S, Deye N, Danguy des Déserts M, Paul M, Thiery G, Simon M, Martin C, Vincent F, Das V, Jacq G, Jacobs F, Soummer A, Mayaux J, Beuret P, Ouchenir A, Durant C, Darmon M, Azoulay E, Sauneuf B, Daubin C, Mongardon N, Biard L, Cariou A, Geeraerts T, Legriel S. Outcomes in 886 Critically Ill Patients After Near-Hanging Injury. Chest 2020; 158:2404-2413. [PMID: 32758563 DOI: 10.1016/j.chest.2020.07.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Louise de Charentenay
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | | | - Nicolas Pichon
- Medical-Surgical Intensive Care Unit, CHU de Limoges, Limoges, France; AfterROSC, Paris, France
| | - Maleka Schenck
- Medical Intensive Care Unit, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierrick Cronier
- AfterROSC, Paris, France; Intensive Care Unit, Sud-Francilien Hospital Center, Corbeil-Essonnes, France
| | - Sebastien Perbet
- Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, Clermont-Ferrand, France
| | - Jean-Baptiste Lascarrou
- AfterROSC, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medicine Intensive Reanimation, University Hospital, Nantes, France
| | - Thomas Rossignol
- Medical-Surgical Intensive Care Unit, Centre Hospitalier du Mans, Le Mans, France
| | - Olivier Lesieur
- AfterROSC, Paris, France; Intensive Care Unit, Saint-Louis Hospital, La Rochelle, France
| | - Laurent Argaud
- AfterROSC, Paris, France; Medical Intensive Care Unit, Hospices Civils de Lyon, Edouard Herriot Teaching Hospital, Lyon, France
| | - Gwenhael Colin
- AfterROSC, Paris, France; Medical-Surgical Intensive Care Unit, La Roche-sur-Yon District Hospital Center, La Roche-sur-Yon, France
| | - Bernard Cholley
- Service de Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Hamid Merdji
- 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
| | - Stein Silva
- AfterROSC, Paris, France; Réanimation Polyvalente, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | | | - Jonathan Chelly
- AfterROSC, Paris, France; Intensive Care Unit, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Marie Salvetti
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | - Segolene Couraud
- Medical-Surgical Intensive Care Unit, GH Le Havre, Le Havre, France
| | - Nicolas Deye
- AfterROSC, Paris, France; Medical Intensive Care Unit, Lariboisière Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Marine Paul
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | - Guillaume Thiery
- Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Marc Simon
- Intensive Care Department, Cliniques du Sud-Luxembourg of Arlon, Arlon, Belgium
| | - Charlotte Martin
- Anesthésie Réanimation, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - François Vincent
- Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France
| | - Vincent Das
- Medical-Surgical Intensive Care Unit, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France
| | - Gwenaelle Jacq
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France
| | - Frederic Jacobs
- Medical Intensive Care Unit, Beclere Teaching Hospital, Clamart, France
| | - Alexis Soummer
- Department of Intensive Care Medecine, Foch Hospital, Suresnes, France
| | - Julien Mayaux
- Department of Pneumology and Intensive Care, Pitie Salpetriere Teaching Hospital, Paris, France
| | - Pascal Beuret
- Department of Intensive and Continuous Care, Roanne Hospital, Roanne, France
| | | | - Caroline Durant
- Intensive Care Unit, Marie-Curie Teaching Hospital, Charleroi, Belgium
| | - Mickael Darmon
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bertrand Sauneuf
- AfterROSC, Paris, France; General Intensive Care Unit, Cotentin Public Hospital Center, Cherbourg-en-Cotentin, France
| | - Cedric Daubin
- AfterROSC, Paris, France; Medical Intensive Care Unit, Caen Teaching Hospital, Caen, France
| | - Nicolas Mongardon
- AfterROSC, Paris, France; Department of Anesthesiology and Surgical Intensive Care Units, Henri Mondor Teaching Hospital, Créteil, France
| | - Lucie Biard
- 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
| | - Alain Cariou
- 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
| | - Thomas Geeraerts
- Anesthésie Réanimation, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - Stephane Legriel
- 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.
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4
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La Count S, Lovett ME, Zhao S, Kline D, O'Brien NF, Hall MW, Sribnick EA. Factors Associated With Poor Outcome in Pediatric Near-Hanging Injuries. J Emerg Med 2019; 57:21-28. [PMID: 31031070 DOI: 10.1016/j.jemermed.2019.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hanging injury is the most common method of suicide among children 5 to 11 years of age and near-hangings commonly occur. Adult studies in near-hanging injury have shown that need for cardiopulmonary resuscitation, initial blood gas, and poor mental status are associated with poor prognosis. The literature for similar factors in children is lacking. OBJECTIVES This retrospective, single-center study was performed to identify the clinical factors associated with neurologic outcome in children after near-hanging. METHODS Inclusion criteria included <18 years of age and a diagnosis of near-hanging or strangulation. All physician documentation was reviewed, and incidences of respiratory complications, seizure, and multiorgan failure were noted. Pediatric cerebral performance category score was based on information at discharge and was defined as favorable (score of 1-4) or unfavorable (score of 5-6). Comparisons were made between outcome groups and suspected clinical factors. RESULTS The median age was 11.5 years with a median initial Glasgow Coma Scale (GCS) score of 10. Of all patients, 25% had a prehospital cardiac arrest, and 51% were admitted to the intensive care unit. Patients with unfavorable outcomes had a lower initial pH (6.9 vs. 7.3) and initial GCS score (3T vs. 14). Patients with an unfavorable outcome had significantly higher rates of intensive care unit admission, respiratory complications, anoxic brain injury, and multiorgan failure. No patient who presented with an initial GCS score of 3T and prehospital cardiac arrest had a favorable neurologic outcome. CONCLUSIONS This is the largest single-center study of children with near-hanging injury. An initial GCS score of 3T and prehospital cardiac arrest was uniformly associated with poor neurologic outcome.
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Affiliation(s)
- Stephanie La Count
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Marlina E Lovett
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Songzhu Zhao
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - David Kline
- Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - Nicole F O'Brien
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Mark W Hall
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Eric A Sribnick
- Division of Neurosurgery, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; Department of Neurosurgery, The Ohio State University, Columbus, Ohio
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