Outcome of patients with attempted suicidal hanging with pre-hospital cardiac arrest: A pilot observational ICU study

Abstract

Background: Hanging with pre-hospital cardiac arrest is associated with increased hospital mortality and significant long-term neurological morbidity.

Setting: Single centre, observational study at tertiary care ICU.

Methods: All patients with suicidal hanging admitted to Westmead ICU from 1-Jan-2014 to 31-Dec-2019 were included in the study. Patient data obtained from ICU database and electronic health record was analysed for predictors of ICU outcome.

Results: Seventy-six patients with suicidal hanging presented to Westmead Emergency Department over a period of 6 years; of these, 47 (33 males, 14 females) were admitted to ICU. Mean age of patient cohort was 39.0 years (+13.6) and median APACHE-III score was 69.0. Twenty-seven patients (57.4%) were admitted following pre-hospital cardiac arrest due to a non-shockable rhythm (16 PEA, 11 asystole) as the first documented rhythm. Most (74.0%) of these patients had GCS of 3 at scene and this remained unchanged on arrival in the ED. This notwithstanding, 33.3% patients had a good neurological outcome. Among hanging patients without pre-hospital cardiac arrest, 95% had a good neurological outcome. This difference in outcome was significant. While several factors were associated with patient outcome on univariate analysis, only high APACHE-III score demonstrated a significant inverse relationship with good outcome on regression analysis. Presence of myoclonus at admission and pre-hospital cardiac arrest also had an inverse association with good outcome, but this was not statistically significant.

Conclusions: Outcome of hanging patients with pre-hospital cardiac arrest admitted to ICU was poor despite successful initial resuscitation as per international guidelines. High APACHE-III score was associated with poor outcome.