Predictors of brain death after hanging-induced cardiac arrest.
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Barrovecchio Boris, Colin Gwenhael, Argaud Laurent, Desmeulles Isabelle, Bailly Pierre, Sedillot Nicholas, Nougue Helene, Pichon Nicolas, Siami Shidasp, Plantefeve Gaetan, Schnell Guillaume, Schenck Maleka, Cronier Pierrick, Perbet Sebastien, Curtiaud Anais, Piagnerelli Michael, Monchi Mehran, Deye Nicolas, Audibert Juliette, Cerf Charles, Aries Philippe, Thiery Guillaume, Das Vincent, Silva Stein, Simon Marc, Jacq Gwenaelle, Jacobs Frederic, Daubin Cedric, Lemiale Virginie, Beuret Pascal, Gele-Decaudin Guillaume, Quenot Jean-Pierre, Lascarrou Jean-Baptiste, Lesieur Olivier, Guitton Christophe, Legriel Stephane, Antigone Investigators
Аннотация
METHODS: Retrospective study including adults with return of spontaneous circulation from hanging-induced cardiac arrest admitted to 34 ICUs in France and Belgium between 2000 and 2024. Logistic multivariate regression was performed to identify factors associated with progression to brain death.
RESULTS: Of the 554 patients with hanging-induced cardiac arrest, brain imaging was performed on admission in 443 (80.0%) patients. Overall, 169/554 (30.5%) and 142/443 (32.1%) patients progressed to brain death within a median time of 3 days, and up to 12 days, after the hanging-induced cardiac arrest. In 443 patients with brain imaging, five factors were independently associated with a higher risk of progression to brain death: female (OR, 1.76; 95% CI, 1.06-2.90; p = 0.03), asystole as first recorded rhythm (OR, 2.03; 95% CI, 1.27-3.29; p = 0.004), low-flow time > 30 min (OR, 1.84; 95% CI, 1.07-3.17; p = 0.03), total Logistic Organ Dysfunction System Score at day 1 (OR, 1.93/per point; 95% CI, 1.14-3.29; p = 0.02), and cerebral oedema and/or ischemic complication on brain CT scan at ICU admission (OR, 1.62; 95% CI, 1.01-2.61, p = 0.04). Conversely, age > 50 years (OR, 0.59; 95%CI, 0.35-0.98, p = 0.04) and status myoclonus ≤ day 2 (OR, 0.24; 95%CI, 0.09-0.54, p = 0.001) were associated with a lower risk of progression to brain death after hanging-induced cardiac arrest.
CONCLUSION: Our findings emphasise the very high rate of brain death after hanging-induced cardiac arrest. In our population, factors associated with brain death after hanging induced cardiac arrest predominantly reflect initial injury severity.