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Original research
Out-of-hospital cardiac arrest due to hanging: a retrospective analysis
  1. Jake Turner1,2,3,
  2. Aidan Brown2,3,
  3. Rhiannon Boldy3,
  4. Jenny Lumley-Holmes3,
  5. Andy Rosser3,
  6. Alex James2,3,4,5
  1. 1 Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2 Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK
  3. 3 West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
  4. 4 Anaesthetic Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  5. 5 School Medicine, University of Keele, Newcastle-under-Lyme, Staffordshire, UK
  1. Correspondence to Dr Jake Turner, Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK; jake.turner3{at}nhs.net

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.

  • pre-hospital
  • cardiac arrest
  • trauma
  • pre-hospital care
  • emergency care systems

Data availability statement

Data may be obtained from a third party and are not publicly available. Non-identifiable data were provided by the national out of hospital cardiac arrest database and the Trauma Audit and Research Network.

https://doi.org/10.1136/emermed-2020-210839

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Non-identifiable data were provided by the national out of hospital cardiac arrest database and the Trauma Audit and Research Network.

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    Footnotes

    • Handling editor Ed Benjamin Graham Barnard

    • Twitter @JakeTurner99

    • Correction notice Since this article was first published online figure 1 has been replaced. The section, 50 ’- no spontaneous circulation prehospital after cardiac arrest identified’ should read ’40-no spontaneous circulation…’. The abstract and discussion sections have also been updated to reflect the change from 50 to 40.

    • Contributors JT and AJ are responsible for the design, data collection, analysis, drafting, revision and final approval. Both are guarantors. AB is responsible for the design, data collection, analysis, drafting and revision. JL-H, RB and AR are responsible for data collection, drafting and revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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