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Paediatric hanging associated out of hospital cardiac arrest in Melbourne, Australia: characteristics and outcomes
  1. C Deasy1,2,3,
  2. J Bray1,
  3. K Smith1,2,
  4. L R Harriss1,2,
  5. S A Bernard1,2,3,
  6. P Cameron2,3 On behalf of the Victoria Ambulance Cardiac Arrest Registry steering committee
  1. 1Ambulance Victoria, Victoria, Australia
  2. 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  3. 3The Alfred Hospital, Melbourne, Victoria
  1. Correspondence to Dr C Deasy, Monash University, Department of Epidemiology and Preventive Medicine, Alfred Hospital, Level 3 Burnet Building, 89 Commercial Road, Melbourne 3004, Australia; conordeasy{at}hotmail.com

Abstract

Introduction Hanging is a rare but devastating cause of out of hospital cardiac arrest (OHCA). The characteristics and outcomes of hanging associated OHCA in the paediatric age group are described.

Methods The Victorian Ambulance Cardiac Arrest Registry was searched for patients aged less than 18 years where the precipitant cause of OHCA was hanging. Results were cross checked with the coronial database.

Results During the years 2000–2009, there were 680 paediatric cardiac arrests of which 53 (7.8%) were precipitated by hanging with an incidence of 4.4 per million paediatric patients (<18 years) per year. Median age was 16 (IQR 14–17) years and 58.5% were males. Five were unintentional hangings; median age 3 (IQR 2–4) years. The youngest deliberate hanging associated OHCA was aged 10 years. Most hangings occurred in a house (85%) and bystander cardiopulmonary resuscitation (CPR) was performed in 30%. Asystole was the most common initial cardiac arrest rhythm seen in 50 cases (94%) while three patients had pulseless electrical activity. The emergency medical services (EMS) attempted resuscitation in 18 patients (34%), inserting an endotracheal tube in 13 patients. The majority (n=41) were not transported; seven patients were transported with return of spontaneous circulation (ROSC) and five patients were transported with ongoing CPR. Victims who had bystander CPR were more likely to have EMS attempted resuscitation (p<0.001). Only patients who had received bystander CPR achieved ROSC (p<0.001). Three patients survived to hospital discharge; two survivors suffered severe neurological injury (Cerebral Performance Category Scale 3–4).

Conclusion Non-intentional hanging is rare but deliberate hanging with suicidal intent represents a significant proportion of OHCAs in patients under 18 years of age. A focus on prevention is key, as outcomes are poor, with survivors likely to suffer a severe neurological insult.

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Footnotes

  • Funding CD is in receipt of an Overseas PhD Student Scholarship from Monash University. Ambulance Victoria and the Coroner's Office provided support.

  • Competing interests None.

  • Ethics approval The study was approved by the Research Committee of Ambulance Victoria, the Department of Justice Research Committee and Monash University Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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