title: Neurologic outcome of comatose survivors after hanging: a retrospective multicenter study.
abstract: OBJECTIVE
  The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors.
  
  
  METHODS
  We retrospectively investigated comatose hanging patients who arrived at the emergency departments (EDs) of twelve academic tertiary care centers during a period of seven years (2006-2012). Patients were analyzed separately according to whether out-of-hospital cardiac arrest (OHCA) occurred or not. The neurologic outcome was evaluated using the Cerebral Performance Category (CPC) at the time of hospital discharge.
  
  
  RESULTS
  A total of 1118 patients were admitted to the ED after hanging attempts. There were 159 comatose patients who did not experience OHCA. Twelve (7.5%) of 159 patients were discharged from the hospital with a poor neurologic outcome (CPC 3-5). These 12 patients received only conservative management without therapeutic hypothermia. On multivariate logistic regression analysis, mental state upon ED arrival and arterial pH were predicting factors for poor prognosis. One hundred twenty-one patients suffered OHCA and experienced restored spontaneous circulation after cardiopulmonary resuscitation. Among them, only five (4.1%) patients recovered consciousness to the level of CPC 1-2. The initial arterial pH and HCO3(-) were prognostic factors in hanging patients with OHCA.
  
  
  CONCLUSIONS
  Even though cardiac arrest did not occur after hanging injuries, 7.5% of patients could not recover consciousness. Therapeutic hypothermia should be considered for such patients. If OHCA occurred after the hanging injury, the proportion of patients with good neurologic outcome was very low at 4.1%.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Inje University Busan Paik Hospital, Busan, Korea.
authors.forename: Yoo Sang
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Joon Min
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Junho
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Emergency Medicine, Bucheon Hospital of Soonchunhyang University, Bucheon, Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Lim
authors.affiliation: Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hyunggoo
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Emergency Medicine, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.
authors.forename: Seung Whan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Kyeong Ryong
authors.initials: KR
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Gun Bea
authors.initials: GB
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Park
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. Electronic address: emstar@yuhs.ac.
authors.forename: Sung Phil
authors.initials: SP
authors.lastname: Chung
mesh_terms: D000328:Adult; D001237:Asphyxia / Q000150:complications* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000150:complications* / Q000628:therapy; D003243:Consciousness; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D013406:Suicide, Attempted; D017741:Survivors