Therapeutic hypothermia for comatose survivors after near-hanging-A retrospective analysis

Background: Patients who survive after suicidal hanging attempts suffer from transient brain ischaemia. Morbidity and mortality is high, and no specific therapy is available. Hypothermia attenuates ischaemic brain damage and has become standard care in comatose survivors of cardiac arrest; therapeutic hypothermia may thus be useful for near-hanging victims as well. Objectives: To perform a literature review on outcome and outcome predictors after near-hanging. To make a retrospective chart review on treatment and outcome of near-hanging victims in two Swedish intensive care units during a 4-year period (2003-2006). Methods: The literature review was conducted as a Medline search. Study patients were identified and data retrieved from the intensive care units' medical records. The primary outcome measure was neurological function at discharge. Results: No randomised, controlled trials were found in the Medline search. Thirteen patients could be identified and were included in the study, all were in coma and three had suffered cardiac arrest. Outcome was good in six of eight patients treated with hypothermia, as compared to three of five patients who were not. All three patients with cardiac arrest received hypothermia treatment and outcome was good in one. Conclusion: No randomised, controlled trial for treatment of near-hanging victims has been published. No conclusions could be drawn regarding treatment effects of hypothermia in this survey, but in the absence of better evidence, it seems reasonable to consider hypothermia treatment in all comatose near-hanging victims. (c) 2008 Elsevier Ireland Ltd. All rights reserved.