• Cindy H Hsu, Bryce E Haac, Mack Drake, Andrew C Bernard, Alberto Aiolfi, Kenji Inaba, Holly E Hinson, Chinar Agarwal, Joseph Galante, Emily M Tibbits, Nicholas J Johnson, David Carlbom, Mina F Mirhoseini, Mayur B Patel, Karen R OʼBosky, Christian Chan, Pascal O Udekwu, Megan Farrell, Jeffrey L Wild, Katelyn A Young, Daniel C Cullinane, Deborah J Gojmerac, Alexandra Weissman, Clifton Callaway, Sarah M Perman, Mariana Guerrero, Imoigele P Aisiku, Raghu R Seethala, Ivan N Co, Debbie Y Madhok, Bryan Darger, Dennis Y Kim, Lara Spence, Thomas M Scalea, and Deborah M Stein.
• From the R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland (C.H.H., B.E.H., T.M.S., D.M.S.); University of Michigan Ann Arbor, Michigan (C.H.H., I.N.C.); University of Kentucky, Lexington, Kentucky (M.D., A.C.B.); Los Angeles County/University of Southern California Medical Center, Los Angeles, California (A.A., K.I.); Oregon Health & Science University, Portland, Oregon (H.E.H., C.E.); University of California Davis Medical Center, Davis, California (J.G., E.M.T.); University of Washington/Harborview Medical Center, Seattle, Washington (N.J.J., D.C.); Vanderbilt University Medical Center, Nashville, Tennessee (M.F.M., M.B.P.); Loma Linda University Medical Center, Loma Linda, California (K.R.O., C.C.); WakeMed Health & Hospitals, Raleigh, North Carolina (P.O.U., M.F.); Geisinger Medical Center, Danville, Pennsylvania (J.L.W., K.A.Y.); Marshfield Clinic, Marshfield, Wisconsin (D.C.C., D.J.G.); University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (A.W., C.C.); University of Colorado Hospital, Aurora, Colorado (S.M.P., M.G.); Brigham Women's Hospital, Boston, Massachusetts (I.P.A., R.R.S.); San Francisco General Hospital/University of California San Francisco, San Francisco, California (D.Y.M., B.D.); Harbor UCLA Medical Center, Torrance, California (D.Y.K., L.S.).
• J Trauma Acute Care Surg. 2018 Jul 1; 85 (1): 37-47.

BackgroundWe sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study.MethodsWe analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome.ResultsA total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy.ConclusionCardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models.Level Of EvidenceTherapeutic study, level IV; prognostic study, level III.

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