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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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Ramadoss R, Sekar D, Rameesh M, Saibaba J, Raman D. Clinical Profile, Corticosteroid Usage and Predictors of Mortality in Near-hanging Patients: A Five-year, Single-center Retrospective Study. Indian J Crit Care Med 2023; 27:403-410. [PMID: 37378362 PMCID: PMC10291671 DOI: 10.5005/jp-journals-10071-24477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 06/29/2023] Open
Abstract
Background Hanging is the most common method of suicide in India. When near-hanging patients reach the hospital for treatment, their neurological outcome ranges from full recovery to severe neurological impairment or death. This study looked at the clinical profile, usage of corticosteroids and predictors of mortality in near-hanging patients. Materials and methods This retrospective study was conducted from May 2017 to April 2022. Demographic, clinical, and treatment details were collected from case records. Neurological outcome at discharge was assessed using the Glasgow Outcome Scale (GOS). Results The study involved 323 patients, 60% of men with a median (interquartile range) age of 30 (20-39). At the time of admission, the Glasgow Coma Scale (GCS) ≤8 in 110 (34%) patients, hypotension was present in 43 (13.3%) of patients, and 21 (6.5%) had hanging-induced cardiac arrest. About 101 patients required intensive care unit care. Corticosteroid therapy was given to 219 patients (67.8%) as part of anti-cerebral edema measures. Good neurological recovery was found (GOS-5) in 84.2% of patients, and the death rate (GOS-1) was 9.3%. Univariate logistic regression showed that usage of corticosteroids is significantly associated with poor survival (p < 0.02, odds ratio 4.7). In the multivariable logistic regression analysis, GCS ≤8, hypotension, need for intensive care, hanging-induced cardiac arrest, aspiration pneumonia, and severe cerebral edema were found to be significantly associated with mortality. Conclusion The majority of near-hanging patients had a good neurological recovery. Corticosteroids were used in two-thirds of the study population. There were multiple variables associated with mortality. How to cite this article Ramadoss R, Sekar D, Rameesh M, Saibaba J, Raman D. Clinical Profile, Corticosteroid Usage and Predictors of Mortality in Near-hanging Patients: A Five-year, Single-center Retrospective Study. Indian J Crit Care Med 2023;27(6):403-410.
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Affiliation(s)
- Ramu Ramadoss
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Dineshbabu Sekar
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Mohamed Rameesh
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Jayaram Saibaba
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Divya Raman
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Kanno K, Yamagami Y, Hanada T, Iwahashi M, Ito Y. A Child With a Glasgow Coma Scale Score of 4 After Near-Hanging: A Case Report on Treatment Without Intubation and Targeted Temperature Management. Cureus 2023; 15:e39581. [PMID: 37378182 PMCID: PMC10292931 DOI: 10.7759/cureus.39581] [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] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
While prehospital medical interventions are evolving and improving survival rates, the evidence for adequate early prognostic assessment is often insufficient. A 12-year-old Japanese child was found hanging on the roof of his home. After being rescued by his mother, he was transported by an ambulance and a rapid response car (RRC) with doctors, nurses, and paramedics on board, and admitted to our hospital. His initial Glasgow Coma Scale score in the RRC was 4. Although he did not undergo intubation and targeted temperature management (TTM), he had no neurological sequelae upon discharge. To the best of our knowledge, this report is the first to describe the case of a child with a decreased level of consciousness after near-hanging, who was treated without intubation and TTM.
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Affiliation(s)
- Koji Kanno
- Department of Pediatric Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Yuji Yamagami
- Department of Pediatric Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Tomoya Hanada
- Department of Pediatric Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Madoka Iwahashi
- Department of Pediatric Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
| | - Yusuke Ito
- Department of Pediatric Emergency and Critical Care Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN
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Kim D, Lee WJ, Lee HW, Kim BS, Woo SH, Yoon HJ. Application of 18F-FDG brain PET for survival prediction in a rat model of hanging-induced hypoxic brain injury. Ann Nucl Med 2022; 36:570-578. [PMID: 35380351 DOI: 10.1007/s12149-022-01738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate prediction of survival outcomes after hanging is a crucial and challenging issue in comatose survivors. In this preclinical study, we evaluated the potential utility of using brain glucose metabolism as measured by fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for survival prediction in a rat model of hanging-induced hypoxic brain injury (HBI). METHODS HBI was induced by mechanical hanging using Sprague Dawley rats. 18F-FDG brain PET images were acquired in 26 HBI rats three hours post-injury (3 h post-injury) and 4 controls. During the 1 month follow-up period, HBI rats were further classified as survivors (n = 15) and nonsurvivors (n = 11). Between-group regional (standardized uptake values normalized to the reference whole brain = SUVRWB, cerebellum = SUVRCB, and pons = SUVRpons) and voxel-based analyses were performed. The prognostic value of the SUVR was tested for overall survival (OS). In addition, diffusion-weighted imaging (DWI) was performed in 2 controls and 5 HBI rats (3 survivors, 2 nonsurvivors, 3 h post), and an apparent diffusion coefficient (ADC) map was generated. RESULTS The nonsurvivor group showed a significantly lower SUVRWB, SUVRCB, and SUVRpons of the cerebral cortices than the survivor group (all p < 0.001). Voxel-based comparison also demonstrated significant reduction in the nonsurvivor group compared with the survivor group (family-wise error-corrected p < 0.05). However, there was no significant difference between controls and survivors. Of 3 reference regions, the SUVRpons demonstrated the largest difference between the survivor and nonsurvivor groups. With an optimal cutoff value of 1.12 (AUC 0.952, p < 0.001), the SUVRpons predicted survival outcomes with a sensitivity of 81.8% and specificity of 100%. The OS of the low SUVRpons group was significantly shorter than that the high SUVRpons group (p < 0.001). The mean ADC values of each brain region showed no significant difference according to survival outcomes. CONCLUSIONS These results suggest the potential utility of 18F-FDG brain PET for predicting survival in hanging-induced HBI.
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Affiliation(s)
- Daehee Kim
- Department of Emergency Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woon Jeong Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Won Lee
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bom Sahn Kim
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
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Soar J, Becker LB, Berg KM, Einav S, Ma Q, Olasveengen TM, Paal P, Parr MJA. Cardiopulmonary resuscitation in special circumstances. Lancet 2021; 398:1257-1268. [PMID: 34454688 DOI: 10.1016/s0140-6736(21)01257-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 12/21/2022]
Abstract
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.
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Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
| | - Lance B Becker
- Emergency Medicine, Zucker School of Medicine at Hofstra-Northwell, Northwell Health, New Hyde Park, NY, USA
| | | | - Sharon Einav
- Surgical Intensive Care, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Qingbian Ma
- Emergency Medicine, Peking University Third Hospital, Beijing, China
| | | | - Peter Paal
- Anaesthesiology and Intensive Care, St John of God Hospital, Paracelsus, Salzburg, Austria
| | - Michael J A Parr
- Intensive Care, Liverpool University Hospital, University of New South Wales, Sydney, NSW, Australia; Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia
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