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Updated: Feb 11, 2026
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.).
Background:
We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study.
Methods:
We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome.
Results:
A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy.
Conclusion:
Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models.
Level Of Evidence:
Therapeutic study, level IV; prognostic study, level III.
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