Outcomes in 886 Critically Ill Patients After Near-Hanging Injury
2020
de Charentenay, Louise | Schnell, Guillaume | Pichon, Nicolas | Schenck, Maleka | Cronier, Pierrick | Perbet, Sébastien | Lascarrou, Jean Baptiste | Rossignol, Thomas | Lesieur, Olivier | Argaud, Laurent | Colin, Gwenhaël | Cholley, Bernard | Quenot, Jean Pierre | Merdji, Hamid | Silva, Stein | Piagnerelli, Michaël | Chelly, Jonathan | Salvetti, Marie | Couraud, Segolene | Deye, Nicolas | Danguy Des Déserts, Marc | Paul, Marine | Thiery, Guillaume | Simon, Marc | Martin, Charlotte | Vincent, François | Das, Vincent | Jacq, Gwenaëlle | Jacobs, Frédéric Marc | Soummer, Alexis | Mayaux, Julien | Beuret, Pascal | Ouchenir, Abdelkader | Durant, Caroline | Darmon, Michaël | Azoulay, Élie | Sauneuf, Bertrand | Daubin, Cédric | Mongardon, Nicolas | Biard, Lucie | Cariou, Alain | Geeraerts, Thomas | Legriel, Stéphane | Girard, Nicolas | Cour, Martin | Prisacariu, Adriaan | Dargent, Auguste | Meziani, Ferhat | Baudic, Thibaut | Vignon, Philippe | Belony, Candice | Leparq, Charlene | Carre, Cécile | Moriss, Pauline | Noel, Emmanuelle | Cavelot, Sébastien | Bachelet, Delphine | de Roux, Quentin | Resche-Rigon, Matthieu | Guitton, Christophe | Mégarbane, Bruno | Cerf, Charles | Demoule, Alexandre | Kalfon, Pierre | Centre Hospitalier de Versailles André Mignot (CHV) | Groupe Hospitalier du Havre | Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges] ; CHU Limoges | After ROSC research network [Paris, France] (AfterROSC) | Hôpitaux Universitaires de Strasbourg (HUS) | Centre Hospitalier Sud Francilien | Génétique, Reproduction et Développement (GReD) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS) | Paris-Centre de Recherche Cardiovasculaire (PARCC (UMR_S 970/ U970)) ; Hôpital Européen Georges Pompidou [APHP] (HEGP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité) | Hôpital Hôtel-Dieu de Nantes - Centre Hospitalier Universitaire de Nantes (Hôpital Hôtel-Dieu de Nantes - CHU de Nantes) | Centre Hospitalier Le Mans (CH Le Mans) | Hopital Saint-Louis [La Rochelle] ; Hôpitaux La Rochelle Ré Aunis [Groupe hospitalier littoral Atlantique] | Hospices Civils de Lyon (HCL) | Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon (CHD Vendée) | Hôpital Européen Georges Pompidou [APHP] (HEGP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO) | Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon) | Fédération de Médecine Translationnelle de Strasbourg (FMTS) ; Université de Strasbourg (UNISTRA) | Nanomédecine Régénérative (NanoRegMed) ; Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM) | Pôle Anesthésie Réanimation [CHU de Toulouse] ; Centre Hospitalier Universitaire de Toulouse (CHU Toulouse) | Groupe Hospitalier Sud Ile-de-France (GHSIF) | Hôpital Lariboisière-Fernand-Widal [APHP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Hôpital d'Instruction des Armées Clermont Tonnerre ; Service de Santé des Armées | Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E) | CHU bobigny | Centre Hospitalier Intercommunal André Grégoire [Montreuil] (CHI André Gregoire) | Hopital Saint-Louis [AP-HP] (AP-HP) ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Hôpital Foch [Suresnes] | CHU Pitié-Salpêtrière [AP-HP] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU) | Centre Hospitalier de Roanne ; Centre Hospitalier de Roanne | Hôpital Louis Pasteur [Chartres] | CH Centre Hospitalier Public du Cotentin (CHPC) | CHU Caen Normandie – Centre Hospitalier Universitaire de Caen Normandie (CHU Caen Normandie) ; Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN) | CHU Henri Mondor [Créteil] | Epidemiology and Clinical Statistics for Tumor, Respiratory, and Resuscitation | Epidémiologie Clinique, STatistique, pour la Recherche en Santé (ECSTRRA [CRESS - U1153 / UMR_A 1125]) ; Centre for Research in Epidemiology and Statistics | Centre de Recherche Épidémiologie et Statistiques (CRESS (U1153 / UMR_A 1125)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) | AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris] ; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP) | Centre de recherche en épidémiologie et santé des populations (CESP) ; Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay | Optimisation thérapeutique en Neuropsychopharmacologie (OPTeN (UMR_S 1144 / U1144)) ; Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité) | 12/17 | FUNDING/SUPPORT: This study was supported by the Délégation à la Recherche Clinique et à l’Innovation de Versailles, the non-profit publicly funded research agency for the Versailles Hospital, Versailles, France [Grant 12/17].
International audience
Показать больше [+] Меньше [-]Английский. Background: Near-hanging experiences are life-threatening events about which few data are available. Research Question: What are the outcomes and early predictors of hospital mortality in critically ill patients who have undergone a near-hanging experience? Study Design and Methods: 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. Results: 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). Interpretation: 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. Trial Registry: ClinicalTrials.gov; No.: NCT04096976; URL: www.clinicaltrials.gov
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