• Louise de Charentenay, Guillaume Schnell, Nicolas Pichon, Maleka Schenck, Pierrick Cronier, Sebastien Perbet, Lascarrou Jean-Baptiste JB AfterROSC, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medicine Intensive Reanimation, University Hospital, Thomas Rossignol, Olivier Lesieur, Laurent Argaud, Gwenhael Colin, Bernard Cholley, Quenot Jean-Pierre JP Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, France., Hamid Merdji, Stein Silva, Michael Piagnerelli, Jonathan Chelly, Marie Salvetti, Segolene Couraud, Nicolas Deye, Marc Danguy des Déserts, Marine Paul, Guillaume Thiery, Marc Simon, Charlotte Martin, François Vincent, Vincent Das, Gwenaelle Jacq, Frederic Jacobs, Alexis Soummer, Julien Mayaux, Pascal Beuret, Abdelkader Ouchenir, Caroline Durant, Mickael Darmon, Elie Azoulay, Bertrand Sauneuf, Cedric Daubin, Nicolas Mongardon, Lucie Biard, Alain Cariou, Thomas Geeraerts, Stephane Legriel, and Antigone Investigators.
• Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France.
• Chest. 2020 Dec 1; 158 (6): 2404-2413.

BackgroundNear-hanging experiences are life-threatening events about which few data are available.Research QuestionWhat are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience?Study Design And MethodsAdult 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.ResultsOf 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).InterpretationThe 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 RegistryClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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