Outcomes in 886 Critically Ill Patients after Near-Hanging Injury.

ABSTRACT Background Near-hanging is a life-threatening event about which few data are available. Research question What are the outcomes and early predictors of hospital mortality in critically ill patients with near-hanging. Study Design and Methods. Adults patients with successful resuscitation of suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively. Cases were identified by searching the hospital databases for ICD-9 and ICD-10 codes and hospital charts for hanging for hanging. Logistic multivariate regression was performed to identify factors associated vital and functional outcomes at hospital discharge as the primary endpoints. 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 [34-52]), 266 (30.0%) had previously attempted suicide, 600 (67.7%) had a diagnosed mental illness, and 55 (6.2%) attempted hanging while hospitalised. Median time from hanging awareness to unhanging was 0 min [0-0] (range 0-82). Median Glasgow Coma Scale (GCS) score was 3 [3-5] at ICU admission. Hanging induced cardiac arrest in 450/886 (50.8%) patients. Overall, 497/886 (56.1%) patients were alive at hospital discharge, including 479/497 (96.4%) with a favourable neuro-cognitive outcome (defined as a Glasgow Outcome Scale score of 4-5). By multivariable analysis, factors associated with hospital mortality were hanging-induced cardiac arrest (OR, 19.50; 95%CI, 7.21-60.90; p 1.4 g/L (OR, 4.34; 95%CI, 1.82-10.81; p=0.0007) and lactate >3.5 mmol/L (OR, 9.98; 95%CI, 4.17-25.36; p Interpretation The findings from this large multicentre retrospective cohort emphasise the very high mortality after hanging injury due chiefly to hanging-induced cardiac arrest. However, patients who survive after near-hanging have excellent neuro-cognitive recovery. Studies of early neuroprotective strategies for patients with near-hanging are warranted.