Therapeutic hypothermia for a comatose survivor of near-hanging.
Therapeutic hypothermia is recommended for comatose survivors of cardiac arrest. Therapeutic hypothermia ameliorates multiple pathophysiologic mechanisms involved in ischemia-reperfusion injury, which may occur after cardiac arrest and near-hanging. Therapeutic hypothermia has not been prospectively studied in near-hanging. Victims of near-hanging suffer from strangulation with cerebral ischemia and resultant reperfusion injury rather than a fatal cervical spine injury. We report a case where therapeutic hypothermia was applied to a comatose survivor of near-hanging. A 41-year-old man presented with coma following attempted suicide by hanging. The patient underwent 24 hours of mild therapeutic hypothermia. The patient was discharged without neurologic sequelae and a Modified Rankin Scale of 0 (back to his baseline status). We present a case where therapeutic hypothermia was used safely and successfully in a patient without cardiac arrest but still in coma after attempted suicide by hanging. No randomized controlled trials on therapeutic hypothermia for comatose survivors of near-hanging victims have been published. However, in the absence of better evidence, it seems reasonable to consider hypothermia treatment in comatose near-hanging victims until more evidence can be obtained.
Critical Care Medicine Department, Neurocritical Care Medicine, St. John's Mercy Medical Center, St. Louis University, St Louis, MO, USA. farid.sadaka@mercy.net
Farid
F
Sadaka
Mary P
MP
Wood
Michael
M
Cox
D000328:Adult; D001237:Asphyxia / Q000209:etiology / Q000628:therapy*; D003128:Coma / Q000209:etiology / Q000628:therapy*; D004636:Emergency Service, Hospital; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D015427:Reperfusion Injury / Q000517:prevention & control; D013406:Suicide, Attempted; D016896:Treatment Outcome