EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest

Cindy H. Hsu, Bryce E. Haac, Mack Drake, Andrew C. Bernard, Alberto Aiolfi, Kenji Inaba, Holly E. Hinson, Chinar Agarwal, Joseph M Galante, Emily M. Tibbits, Nicholas J. Johnson, David Carlbom, Mina F. Mirhoseini, Mayur B. Patel, Karen R. O'Bosky, Christian Chan, Pascal O. Udekwu, Megan Farrell, Jeffrey L. Wild, Katelyn A. YoungDaniel C. Cullinane, Deborah J. Gojmerac, Alexandra Weissman, Clifton Callaway, Sarah M. Perman, Mariana Guerrero, Imoigele P. Aisiku, Raghu R. Seethala, Ivan N. Co, Debbie Y. Madhok, Bryan Darger, Dennis Y. Kim, Lara Spence, Thomas M. Scalea, Deborah M. Stein

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)37-47
Number of pages11
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number1
DOIs
StatePublished - Jul 1 2018

Keywords

  • cardiac arrest
  • Hanging
  • post-cardiac arrest prognostication
  • targeted temperature management
  • therapeutic hypothermia

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Hsu, C. H., Haac, B. E., Drake, M., Bernard, A. C., Aiolfi, A., Inaba, K., Hinson, H. E., Agarwal, C., Galante, J. M., Tibbits, E. M., Johnson, N. J., Carlbom, D., Mirhoseini, M. F., Patel, M. B., O'Bosky, K. R., Chan, C., Udekwu, P. O., Farrell, M., Wild, J. L., ... Stein, D. M. (2018). EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest. Journal of Trauma and Acute Care Surgery, 85(1), 37-47. https://doi.org/10.1097/TA.0000000000001945