Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay, France.
Medical-Surgical Intensive Care Unit, GH Le Havre, Le Havre, France.
Chest. 2020 Dec;158(6):2404-2413. doi: 10.1016/j.chest.2020.07.064. Epub 2020 Aug 3.
Near-hanging experiences are life-threatening events about which few data are available.
What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience?
Adult 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.
Of 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).
The 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.
ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov.
近乎悬垂的经历是危及生命的事件，对此类事件的数据知之甚少。
在经历近乎悬垂的危重症患者中，哪些是医院死亡率的结局和早期预测指标？
回顾性研究了 1992 年至 2014 年间法国和比利时 31 所大学或大学附属医院成功复苏后因自杀性近乎悬垂损伤而入院的成年患者。通过搜索医院数据库中疾病和相关健康问题的国际统计分类，第 9 版和第 10 版代码和医院图表中悬挂的内容来识别患者。进行逻辑多元回归以确定与主要终点（即出院时生命和功能结局相关的因素）相关的因素。次要结局是评估时间趋势和确定医院死亡率的预测因素。
在 886 名患者（181 名女性和 705 名男性；中位年龄 43 岁；四分位距 34-52 岁）中，266 名（30.0%）有自杀既往史，600 名（67.7%）有明确的精神疾病，55 名（6.2%）在住院期间试图上吊。从意识到上吊到解吊的中位时间为 0 分钟（四分位距 [IQR]，0-0；范围，0-82 分钟）。入院时格拉斯哥昏迷量表评分为 3 分（IQR，3-5）。886 名患者中，450 名（50.8%）因悬挂导致心脏骤停。总体而言，886 名患者中有 497 名（56.1%）在出院时存活，其中 479 名（497 名患者中的 96.4%）神经认知结局良好（定义为格拉斯哥结局量表评分为 4 或 5）。通过多变量分析，与医院死亡率相关的因素是悬挂引起的心脏骤停（OR，19.50；95%CI，7.21-60.90；P<0.00001）和 ICU 入院时血糖水平>1.4 g/L（OR，4.34；95%CI，1.82-10.81；P=0.0007）和乳酸水平>3.5 mmol/L（OR，9.98；95%CI，4.17-25.36；P<0.00001）。
这项大型多中心回顾性队列研究的结果强调了近乎悬垂伤后死亡率极高，主要是因为悬挂引起的心脏骤停。然而，经历近乎悬垂经历的患者可实现出色的神经认知恢复。需要研究针对经历近乎悬垂的患者的早期神经保护策略。
ClinicalTrials.gov；编号：NCT04096976；网址：www.clinicaltrials.gov。
