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Doan TN, Rashford S, Sims L, Wilson K, Garner S, Bosley E. Suicide-Related Out-of-Hospital Cardiac Arrests in Queensland, Australia: Temporal Trends of Characteristics and Outcomes over 14 Years. PREHOSP EMERG CARE 2023; 28:431-437. [PMID: 37364032 DOI: 10.1080/10903127.2023.2230595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Research into suicide-related out-of-hospital cardiac arrests (OHCA) using OHCA registries is scant. A more complete understanding of methods, patient characteristics, and outcomes is essential to inform prehospital management strategies and public health interventions. METHODS Included were all OHCA attended by Queensland Ambulance Service (Australia) paramedics between 1 January 2007 and 31 December 2020, where suicide-related causes could be identified. Age- and sex-standardized incidence rates were calculated. Suicide methods, patient characteristics, and survival outcomes were described. Factors associated with survival outcomes were investigated. RESULTS Seven thousand three hundred and fifty-six suicide-related OHCA cases were included. The incidence rates increased from 9.0 per 100,000 population in 2007 to 12.4 in 2020. The incidence rates for males were four times those for females; however, incidence rates for females have increased faster than for males. Hanging was the most common suicide method (63%). Twenty-three percent of patients received resuscitation attempts by paramedics. Among those, the rates of return of spontaneous circulation (ROSC) sustained to hospital arrival, survival to hospital discharge, and survival to 30 days were 28.6, 8.5, and 8.0%, respectively. Over time, the rates of ROSC upon hospital arrival increased, whereas the rates of survival to discharge and 30-day survival remained stable. CONCLUSION The incidence of prehospital-identified suicide-related OHCA in Queensland has increased over time. The prognosis of suicide-related OHCA is poor. Prevention measures should focus on early identification and treatment of individuals having a high risk of suicide. Emergency medical services need to have sufficient training for telecommunicators and paramedics in suicide risk assessment and identification.
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Affiliation(s)
- Tan N Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Stephen Rashford
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Louise Sims
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Kirsten Wilson
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Sandra Garner
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
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2
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Albargi H, Mallett S, Berhane S, Booth S, Hawkes C, Perkins GD, Norton M, Foster T, Scholefield B. Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study. Resuscitation 2021; 170:17-25. [PMID: 34748765 DOI: 10.1016/j.resuscitation.2021.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (BCPR) is strongly advocated by resuscitation councils for paediatric out-of-hospital cardiac arrests (OHCAs). However, there are limited reports on rates of BCPR in children and its relationship with return of spontaneous circulation (ROSC) or survival outcomes. OBJECTIVE We describe the rate of BCPR and its association with any ROSC and survival- to- hospital-discharge. METHODS We conducted retrospective analysis of prospectively collected paediatric (<18 years of age) OHCA cases in England; we included specialist registry patients treated by emergency medical services (EMS) with known BCPR status and outcome between January 2014 and November 2018. Data included patient demographics, aetiology, witness status, initial rhythm, EMS, season, time of day and bystander status. Associations between BCPR, and any ROSC and survival-to-hospital-discharge outcomes were explored using multivariable logistic regression. RESULTS There were 2363 paediatric OHCAs treated across 11 EMS regions. BCPR was performed in 69.6% (1646/2363) of the cases overall (range 57.7% (206/367) to 83.7% (139/166) across EMS regions). Only 34.9% (550/1572) of BCPR cases were witnessed. Overall, any ROSC was achieved in 22.8% (523/2289) and survival to hospital discharge in 10.8% (225/2066). Adjusted odds ratio (aOR) for any ROSC was significantly improved following BCPR compared to no BCPR (aOR 1.37, 95% CI 1.03-1.81), but adjusted odds ratio for survival-to-hospital-discharge were similar (aOR 1.01, 95% CI 0.66-1.55). CONCLUSIONS BCPR was associated with improved rates of any ROSC but not survival-to-hospital-discharge. Variations in EMS BCPR rates may indicate opportunities for regional targeted increase in public BCPR education.
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Affiliation(s)
- H Albargi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Emergency Medical Services Department, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
| | - S Mallett
- UCL Centre for Medical, University College London, London W1W 7TY, UK
| | - S Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; Institute of Applied Health Research, University of Birmingham, UK
| | - S Booth
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - C Hawkes
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - G D Perkins
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK; Department of Critical Care Medicine, Heartlands Hospital, University Hospitals Birmingham, B9 5SS, UK
| | - M Norton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK; School of Medicine, University of Sunderland, Chester Road, Sunderland SR1 3SD, UK
| | - T Foster
- East of England Ambulance Service NHS Trust, Whiting Way, Melbourn, Cambs SG8 6EN, UK
| | - B Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK.
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Turner J, Brown A, Boldy R, Lumley-Holmes J, Rosser A, James A. Out-of-hospital cardiac arrest due to hanging: a retrospective analysis. Emerg Med J 2021; 39:106-110. [PMID: 33931431 DOI: 10.1136/emermed-2020-210839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA). METHODS Data from a UK ambulance service cardiac arrest registry were extracted for all cases in which treatment was provided for OHCA due to hanging between 1 January 2013 and 30 June 2018. Cases were linked to outcome data obtained from the Trauma Audit and Research Network. Comparison of the cohort was made to previously published data from a UK study of all-cause OHCA with 95% CIs calculated for the proportional difference between the studies in selected presentation and outcome variables. RESULTS 189 cases were identified. 95 patients were conveyed to hospital and four of these survived to discharge. 40 patients were conveyed despite absence of a spontaneous circulation and none of these patients survived. While only three patients were initially in a shockable rhythm, DC shocks were administered in 20 cases. There was one case of failed ventilation prompting front-of-neck access for oxygenation. By comparison with all-cause OHCA the proportion of patients with a spontaneous circulation at hospital handover was similar (27.0% vs 27.5%; 0.5% difference, 95% CI -5.9% to 6.8%, p=0.882) but survival to hospital discharge was significantly lower (2.2% vs 8.4%; 6.2% difference, 95% CI 4.1% to 8.3%, p=0.002). CONCLUSION Clinical outcomes following OHCA due to hanging are poor, particularly when patients are transported while in cardiac arrest. Failure to ventilate was uncommon, and clinicians should be alert to the possibility of shockable rhythms developing during resuscitation.
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Affiliation(s)
- Jake Turner
- Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Aidan Brown
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Rhiannon Boldy
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | | | - Andy Rosser
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Alex James
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK.,Anaesthetic Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School Medicine, University of Keele, Newcastle-under-Lyme, Staffordshire, UK
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Abstract
Background In the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice. Methods A five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England. Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised. Results Sixteen papers were included in the review. Australia was the most frequent source of studies (n = 5, 31%). Most studies (n = 11, 69%) were published in the past 10 years. The median sample size was 53 (IQR 41-988, range 10-3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes. Conclusion Hanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focused on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings.
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Affiliation(s)
- Gary Shaw
- North East Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-5279-1412
| | - Lee Thompson
- North East Ambulance Service NHS Foundation Trust
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Paul SP, Paul R, Heaton PA. Accidental hanging injuries in children: recognition and management. Br J Hosp Med (Lond) 2019; 78:572-577. [PMID: 29019723 DOI: 10.12968/hmed.2017.78.10.572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Accidental hanging is rare in childhood but is often fatal. Window blind cords pose a particular and unique risk to young children in the UK, accounting for one to two deaths annually. These accidents are frequently associated with non-adherence to the safety instructions provided by the manufacturers. Early discovery of the child and initiation of effective cardiopulmonary resuscitation at the site of the incident are likely to improve the outcome. Prolonged suspension, children who are pulseless at first contact by the emergency paramedic responder, and patients with prolonged periods of remaining in asystole before return of spontaneous circulation after starting cardiopulmonary resuscitation are unlikely to have intact neurological survival. Management in the hospital includes early airway protection by intubation, maintenance of normal oxygen saturation, normothermia, active control of clinical and sub-clinical seizures, and strict electrolyte and glucose regulation. Child safeguarding concerns should be considered when children have asphyxial injuries, and other signs of child physical abuse should be actively looked for. There is a need for stronger legislation in the UK to prevent some of these accidents, especially those relating to window blind cords.
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Affiliation(s)
- Siba P Paul
- Consultant Paediatrician, Department of Paediatrics, Torbay Hospital, Torquay TQ2 7AA
| | - Ruby Paul
- Year 5 Medical Student, Peninsula College of Medicine and Dentistry, Plymouth
| | - Paul A Heaton
- Consultant Paediatrician, Department of Paediatrics, Yeovil District Hospital, Yeovil
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6
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Kao CL, Hsu IL. Predictors of functional outcome after hanging injury. Chin J Traumatol 2018; 21:84-87. [PMID: 29454810 PMCID: PMC5911731 DOI: 10.1016/j.cjtee.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/23/2017] [Accepted: 05/01/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Suicide becomes a serious problem in today's society and hanging is a common method of suicide. We want to find the factors which can predict the final functional outcomes of these cases. METHODS All patients who presented to Accident and Emergency Department (ED) of the National Cheng Kung University Hospital from 1st January 2005 to 31th December 2013 with a hanging injury were included in this study. All cases were divided into good outcome group and bad outcome group according to Glasgow Outcome Scale (GOS). Data was analyzed by Mann-Whitney test and chi-square test. RESULTS Glasgow Coma Scale (GCS) < 3, pupil dilation and no pupillary light reflex both at the scene and ED were the factors to indicate poor functional outcome. Out-hospital cardiac arrest (OHCA), acidosis (pH < 7.2) and the need for intubation once arriving at ED were also related to poor functional outcome. OHCA cases all had poor functional outcome. CONCLUSION GCS, pupil size, pupillary light reflex, OHCA and acidosis are useful as prognostic factors. GCS = 3 lead to a very poor outcome. However, the functional outcome seems good in patients with GCS>3. There parameters can help to predict the outcome before treatment.
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Affiliation(s)
- Chia-Lung Kao
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City
| | - I-Lin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City,Corresponding author.
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Abstract
OBJECTIVES Hanging may inflict laryngotracheal injuries and increase the potential for difficult airway management. We describe the management of pediatric hangings attended by an urban physician-led prehospital trauma service to provide information on a clinical situation encountered infrequently by most acute care clinicians. METHODS Retrospective trauma registry-based observational study of all children younger than 16 years attended with hanging as mechanism of injury in the period between 2000 and 2014. RESULTS Twenty-three thousand one hundred thirty patients were attended; 2415 (10%) of which were children. Of these, 32 cases (<1%) were pediatric hanging (1 case excluded due to missing data). There were 22 (71%) boys and 9 (29%) girls. Median age was 13 years. There was suicidal intent in 23 (74%) cases, and in 8 (26%) cases, hanging was accidental. There were 17 (55%) deaths, of which 14 (82%) were suicides.The doctor-paramedic team intubated 25 (80%) patients, with a 100% success rate. One (3%) patient was managed with a supraglottic airway device, and 5 (16%) patients did not require any advanced airway management. CONCLUSIONS Pediatric hanging is rare, but has a high mortality rate. Attempted suicide is the leading cause of hangings in children and preventive measures should target psychiatric morbidity. Despite concerns about airway edema or laryngeal injury, experienced doctor-paramedic teams had no failed airway attempts.
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8
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Inoue M, Tohira H, Williams T, Bailey P, Borland M, McKenzie N, Brink D, Finn J. Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia. Emerg Med Australas 2016; 29:69-76. [DOI: 10.1111/1742-6723.12657] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/24/2016] [Accepted: 07/10/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Madoka Inoue
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Teresa Williams
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
| | - Paul Bailey
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
- Emergency Department; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Meredith Borland
- Schools of Paediatric and Child Health, and Primary, Aboriginal and Rural Health Care; The University of Western Australia; Perth Western Australia Australia
- Emergency Department; Princess Margaret Hospital for Children; Perth Western Australia Australia
| | - Nicole McKenzie
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
| | - Deon Brink
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine; Curtin University; Perth Western Australia Australia
- St John Ambulance Western Australia (SJA-WA); Perth Western Australia Australia
- School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
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9
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Successful therapeutic hypothermia for children surviving near-hanging. Am J Emerg Med 2016; 34:1738.e5-7. [DOI: 10.1016/j.ajem.2015.12.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/13/2022] Open
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10
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Sakurai A, Kinoshita K, Komatsu T, Yamaguchi J, Sugita A, Ihara S. Comparison of Outcomes Between Patients Treated by Therapeutic Hypothermia for Cardiac Arrest Due to Cardiac or Respiratory Causes. Ther Hypothermia Temp Manag 2016; 6:130-4. [PMID: 27227748 DOI: 10.1089/ther.2015.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Outcome for patients experiencing out-hospital cardiac arrest (OHCA) due to respiratory causes is poor, even with treatment by therapeutic hypothermia (TH). The purpose of this study is to clarify difference in outcome and respiratory state during resuscitation between cases due to respiratory causes versus those due to cardiac causes, to establish alternative strategies for the patient. This study was conducted as a retrospective analysis of patients with post CA syndrome who underwent TH. Patients were divided into two groups according to cause of CA: cardiac (C group) or respiratory (R group). Utstein Style data, outcome, and arterial blood gas (ABG) findings after emergency room admission of the two groups were compared. Of 74 patients treated with TH during the 2-year study period, 49 were placed in the C group and 19 in the R group. The rates of ventricular fibrillation/pulseless ventricular tachycardia at initial rhythm were significantly higher in the C group than in the R group. The rate of favorable neurological outcome was significantly higher in the C group (15/49: 30.6%) than in the R group (1/19: 5.3%) 30 days after resuscitation. In the ABG findings, PaCO2 was significantly higher in the R group than in the C group. For patients experiencing OHCA from respiratory causes, TH was less effective and PaCO2 accumulated immediately after admission. From this, interpretation of the significance of PaCO2 in these patients at the early stage after return of spontaneous circulation should be seriously considered.
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Affiliation(s)
- Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
| | - Kosaku Kinoshita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
| | - Tomohide Komatsu
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
| | - Atsunori Sugita
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
| | - Shingo Ihara
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 527] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Kim SJ, Shin SD, Lee EJ, Ro YS, Song KJ, Lee SC. Epidemiology and outcomes of out-of-hospital cardiac arrest according to suicide mechanism: a nationwide observation study. Clin Exp Emerg Med 2015; 2:95-103. [PMID: 27752579 PMCID: PMC5052863 DOI: 10.15441/ceem.15.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/15/2015] [Accepted: 04/19/2015] [Indexed: 11/23/2022] Open
Abstract
Objective Suicide remains a serious, preventable public health problem. This study aims to describe the epidemiological characteristics associated with various suicide methods and to investigate outcomes after suicide-associated sudden cardiac arrest (S-SCA), stratified by different suicide attempt methods. Methods An S-SCA database was constructed from ambulance run sheets and augmented by a review of hospital medical records from 2008 to 2010 in Korea. The cases with non-cardiac etiologies and suicide attempts were initially extracted. Suicide attempts were classified as hanging, poisoning, fall, and other. The primary end point was survival to discharge. Age- and sex-adjusted incidence rates were calculated for each suicide method. Adjusted odds ratios for outcome were calculated with adjustments for potential confounding variables. Results A total 5,743 patients were analyzed as S-SCAs. The most common method of suicide attempt was hanging (58.7%), followed by falls (17.6%), poisoning (17.5%), and others (5.8%). The survival to discharge rates were 2.1% (n=119) overall, 2.4% in hanging, 2.4% in poisoning and 0.5% in fall, respectively. The age- and sex-adjusted incidence rates (male/female) per million persons was 32.7 (35.8/29.7) in 2008, 41.8 (46.0/37.7) in 2009, and 43.0 (50.1/36.0) in 2010. Compared with hanging, adjusted odds ratios (95% confidence intervals) for survival to discharge was 1.05 (0.60 to 1.83) for poisoning and 0.08 (0.03 to 0.21) for falls. Conclusion In this nationwide S-SCA cohort study from 2008 to 2010, the standardized incidence rate increased annually. However, the rate of survival to discharge remains very low.
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Affiliation(s)
- Soo Jin Kim
- Seoul National University Graduate School of Medicine, Seoul, Korea; Seoul Metropolitan Fire Service Academy, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Jung Lee
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jin U, Park JS, Min YG, Yang HM, Lim HS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ, Shin JH. Hanging-associated left ventricular systolic dysfunction. Resuscitation 2014; 88:1-5. [PMID: 25513743 DOI: 10.1016/j.resuscitation.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUNDS Although hanging injury is infrequent, its clinical course is usually devastating. Hanging patients usually need cardiopulmonary resuscitation (CPR). However, hanging-associated cardiovascular damage has not been fully established. The aim of this study was to evaluate echocardiographic findings in patients with hanging injury. METHODS We enrolled 25 patients (nine males and 16 females with mean age of 33±15 years) with hanging injury. Echocardiography was performed within 2 weeks after admission. Clinical, demographic, and laboratory data as well as transthoracic echocardiographic findings were analyzed. RESULTS Of the 25 patients, eight (two males and six females with mean age of 34±13 years) showed left ventricular systolic dysfunction (LVSD). Mean LV ejection fraction was 34±16%. Global hypokinesia was present in one patient. Apical ballooning with sparing of the basal segment was present in two patients. Basal akinesia and apical hyperkinesia were present in one patient. Four patients showed regional wall motion abnormalities unmatched with coronary territories. The duration of suspension or CPR was not significantly different according to the presence of LVSD. CONCLUSION This study showed the echocardiographic findings in considerable numbers of patients with hanging injury for the first time. Variable patterns of LVSD were present in patients with hanging injury.
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Affiliation(s)
- Uram Jin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Hyoung-Mo Yang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Byoung-Joo Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - So-Yeon Choi
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, South Korea.
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15
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Abstract
Hanging is an important and increasingly common method of suicide in developed countries. Little is known about the true human pathophysiological changes and injury patterns associated with hanging and near hanging. Cervical spine injury is commonly reported; however, there is a paucity of large data sets concerning this injury. This review article focuses on the incidence of cervical spine and associated neck injuries and their role in morbidity and mortality following non-judicial hanging. A total of 26 heterogeneous studies were identified examining injury after hanging or near hanging. In total, there were 2795 patients; 1530 (54.7%) with true hanging and 1265 (45.3%) with near hanging. Cervical spine injury was reported in a total of 58 (2.08%) patients. Injuries to the airway and vessels of the neck seem rare. This is somewhat lower than the current accepted incidence for cervical spine injury after hanging or blunt force trauma. The overall incidence of cervical spine injury after hanging is low. Spinal immobilisation should probably be instituted depending on the mechanism of the hanging. However, a patient presenting with signs of life to an emergency department is unlikely to have a severe cervical spine injury.
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Affiliation(s)
- Marc Chikhani
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
| | - Robert Winter
- Academic Anaesthesia and Critical Care, Division of Clinical Neuroscience, The University of Nottingham, UK
- Nottingham University Hospitals NHS Trust, Medial Lead, Mid-Trent Critical Care Network, UK
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16
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Evaluation and management of pediatric near-hanging injury. Int J Pediatr Otorhinolaryngol 2013; 77:1899-901. [PMID: 24094721 DOI: 10.1016/j.ijporl.2013.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Children surviving a strangulation event are unique from adults in that they are at risk for significant airway compromise due to the smaller relative size of their airways. To date, no study has specifically evaluated the laryngeal findings and management of pediatric near-hanging patients. METHODS A retrospective chart review was performed on all near-hangings presenting to the a tertiary care children's hospital from January 2001 until June 2010. Demographic information was compiled in addition to laryngeal findings. RESULTS Sixteen children were identified. Four had a documented laryngeal injury, one of which was a major injury requiring a tracheotomy. CONCLUSION Laryngeal examination should be standard of care for any child presenting after a near-hanging event.
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