title: Hanging-associated out-of-hospital cardiac arrests in Melbourne, Australia.
abstract: BACKGROUND
  Hanging is an infrequent but devastating cause of out-of-hospital cardiac arrest (OHCA). We determine the characteristics and outcomes of hanging-associated OHCA in Melbourne Australia.
  
  
  METHODS
  A 10-year retrospective case review of all adult hangings (aged ≥16 years) associated with OHCA, was conducted using data from the Victorian Ambulance Cardiac Arrest Registry.
  
  
  RESULTS
  Between 2000 and 2009, the emergency medical service (EMS) attended 33 178 adult OHCAs of which 1321 (4%) had hanging as the aetiology. The median age (IQR) of hanging-associated OHCA cases was 39 (29-51) years and 1162 were men (88%). The first recorded rhythm by EMS was asystole seen in 1276 (75.5%) patients, pulseless electrical activity (PEA) in 38 (13.4%) cases and ventricular fibrillation in 7 cases (0.5%). EMS attempted resuscitation in 208 (15.7%) patients of whom 61 (29.3%) achieved return of spontaneous circulation (ROSC) and were transported, and 7 (3.3%) survived to hospital discharge. Hanging-associated OHCAs were younger (median (IQR) 38 (29-51) years versus 74 (61-82) years, p<0.001), less likely to have a shockable rhythm (0.5% vs 17.2%, p<0.001), receive bystander cardiopulmonary resuscitation (14.1% vs 25.5%, p<0.001) or an attempted resuscitation by EMS (15.7% vs 36.1%, p<0.001) compared with OHCA cases with an aetiology of 'presumed cardiac' arrest. Multivariable logistic regression identified factors associated with EMS decision to attempt resuscitation; the adjusted OR (95% CI) for 'presence of bystander cardiopulmonary resuscitation' was 15.8 (10.70-23.30) and for 'witnessed arrest' was 5.26 (1.17-23.30).
  
  
  CONCLUSIONS
  Attempted resuscitation was not always futile with a survival of 3.3%. A preventive focus is needed.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 5 Floor, 99 Commercial Road, Melbourne 3004, Australia. conordeasy@hotmail.com
authors.forename: Conor
authors.initials: C
authors.lastname: Deasy
authors.forename: Janet
authors.initials: J
authors.lastname: Bray
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013405:Suicide / Q000706:statistics & numerical data*; D015996:Survival Rate