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Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest
Cindy H Hsu1, Bryce E Haac, Mack Drake
1From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland (C.H.H., B.E.H., T.M.S., D.M.S.); University of Michigan Ann Arbor, Michigan (C.H.H., I.N.C.); University of Kentucky, Lexington, Kentucky (M.D., A.C.B.); Los Angeles County/University of Southern California Medical Center, Los Angeles, California (A.A., K.I.); Oregon Health & Science University, Portland, Oregon (H.E.H., C.E.); University of California Davis Medical Center, Davis, California (J.G., E.M.T.); University of Washington/Harborview Medical Center, Seattle, Washington (N.J.J., D.C.); Vanderbilt University Medical Center, Nashville, Tennessee (M.F.M., M.B.P.); Loma Linda University Medical Center, Loma Linda, California (K.R.O., C.C.); WakeMed Health & Hospitals, Raleigh, North Carolina (P.O.U., M.F.); Geisinger Medical Center, Danville, Pennsylvania (J.L.W., K.A.Y.); Marshfield Clinic, Marshfield, Wisconsin (D.C.C., D.J.G.); University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.W., C.C.); University of Colorado Hospital, Aurora, Colorado (S.M.P., M.G.); Brigham Women's Hospital, Boston, Massachusetts (I.P.A., R.R.S.); San Francisco General Hospital/University of California San Francisco, San Francisco, California (D.Y.M., B.D.); Harbor UCLA Medical Center, Torrance, California (D.Y.K., L.S.).
Suicidal hanging patients with cardiac arrest (CA) have worse outcomes. Targeted temperature management (TTM) in CA patients showed worse unadjusted survival, but subgroup analysis revealed no significant difference.
Area of Science:
- Emergency Medicine
- Critical Care Medicine
- Neurology
Background:
- Suicidal hanging is a significant cause of traumatic injury.
- Cardiac arrest (CA) following suicidal hanging presents unique challenges in patient management.
- The impact of targeted temperature management (TTM) on outcomes after hanging-induced CA is not well understood.
Purpose of the Study:
- To determine the outcome of suicidal hanging.
- To evaluate the effect of TTM on hanging-induced CA.
- To identify predictors of survival and neurologic outcome in this patient population.
Main Methods:
- A multicenter retrospective study analyzed data from 692 hanging patients (January 1992-December 2015).
- Cerebral Performance Category scores were used to define good (1-2) and poor (3-4) neurologic outcomes.
- Classification and Regression Trees (CART) were employed to develop predictive models for survival and neurologic outcome.
Main Results:
- Overall survival was 77%; CA survival was 28.6%.
- CA patients exhibited higher illness severity and poorer outcomes compared to non-CA patients.
- TTM was administered to 46.3% of CA survivors; unadjusted survival and good neurologic outcomes were worse in TTM patients, but subgroup analysis (GCS 3-8) showed no significant difference.
Conclusions:
- Cardiac arrest in hanging patients is associated with worse outcomes.
- While unadjusted outcomes were poorer with TTM, variable implementation and post-CA management may confound results.
- Further prospective studies are needed to clarify TTM's role in hanging-induced CA outcomes.
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