Indications for Targeted Temperature Management in Patients After Choking or Suicide Hanging
Objective: Patients after cardiac arrest from suffocation (airway obstruction caused by foreign body aspiration) or hanging could not have improved prognoses even after undergoing targeted temperature management (TTM). Therefore, to obtain characteristics of such patients, we retrospectively evaluated patients’ data including other pathologies.
Methods: Sixty patients, who suffered cardiopulmonary arrest inside or outside our hospital from June 2009 to July 2016 and received TTM, were assessed. The patients were classified into the two groups: CPC1–CPC2 and CPC3–CPC5 at hospital discharge for parameter comparisons. JMP7.0 was used for statistical analysis, while the Wilcoxon rank sum test and χ2 test were used for testing statistical significance.
Results: Among 60 patients receiving TTM, 40 were male and 20 female. The average age was 64. Nine patients had airway obstructions due to foreign body aspiration or hanging, while 51 patients died due to other diseases such as ventricular fibrillation, cardiac infarction, and bronchial asthma. The overall average pH upon arrival was 6.99, while the overall average serum potassium was 4.68 mEq/L. In two cases, the airway obstruction and hanging were witnessed, while four patients received bystander CPR. None of the nine patients with airway obstruction due to foreign body aspiration or hanging was evaluated as CPC1–CPC2, while 16 (31%) out of 51 patients with other diseases were neurologically favorable. All nine patients with airway obstructions were determined as poor outcomes (CPC3–CPC5), while those in the other causes were 35 out of 51 subjects (100 vs. 68%, p = 0.0497).
Discussion: From the results of our hospital, we assume that TTM resulted in no improvements in the outcomes of patients who suffered airway obstruction due to foreign body aspiration or hanging. In general, some facilities do not actively indicate TTM for patients who suffered airway obstructions. However, improved prognoses have been reported in some case reports (“The 53-year-old man who was out-of-hospital asystole recovered without a problem neurologically.” Intern Emerg Med 2009;4:445–7. “A case in which TTM was used successfully in a patient with coma after cardiorespiratory arrest induced by hanging.” Resuscitation 2005;67:143–4. “Neurologically uneventful 2 hanging cases.” Med J Niigata City General Hospital 2015;36(1)), suggesting the need for further accumulation of subjects to select indicated victims for TTM.
KeywordsCardiac arrest due to suffocation/hanging TTM (targeted temperature management) pH at admission (arrival) Bystander CPR
The authors have no conflicts of interest directly relevant to the content of this article.
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