Outcome of suicidal hanging patients and the role of targeted temperature management in hanging-induced cardiac arrest.

BACKGROUND: No specific treatment is available for hanging-induced cardiac arrest (CA). We hypothesized that targeted temperature management (TTM) may improve the outcome of hanging-induced CA patients at hospital discharge.

METHODS: A retrospective chart review of our trauma registry from January 1999 to September 2015 was conducted to identify patients 18 years or older with hanging as their injury type. All TTMs were performed to achieve 32°C to 34°C for 24 hours. The survival and Cerebral Performance Category scores at hospital discharge were determined.

RESULTS: We identified 138 patients. Their average age was 32.1 ± 10.0 years; 81.3% were men, and 69.8% were white. The mortality rate was 15.2% (21 of 138). Overall, 79.7% (110 of 138) of the near-hanging patients did not sustain out-of-hospital CA (non-CA), and 1.8% of them (2 of 110) received TTM. All 110 non-CA patients survived to hospital discharge and 99.1% (109 of 110) had good neurologic outcome. The remaining 20.3% (28 of 138) of hanging patients suffered out-of-hospital CA; six of these patients were dead on arrival and thus excluded from further analysis. TTM was performed for 40.9% (9 of 22) of the remaining CA patients; 44.4% (4 of 9) of TTM CA patients survived to hospital discharge versus 23.1% (3 of 13) of non-TTM CA patients. There were no significant differences between the overall survival and patients discharged with good neurologic outcome between the TTM and non-TTM CA groups.

CONCLUSION: Non-CA near-hanging patients are more likely to have favorable outcome than the CA patients. Our study was not large enough to detect survival and neurologic outcome differences between the TTM and non-TTM CA groups. A multicenter retrospective study is underway to determine the impact of TTM on the outcome of hanging-induced CA patients.

LEVEL OF EVIDENCE: Therapeutic study, level IV; prognostic study, level IV.