EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest

Hsu, Cindy H.; Haac, Bryce; Drake, Mack; Bernard, Andrew C.; Aiolfi, Alberto; Inaba, Kenji; Hinson, Holly E.; Agarwal, Chinar; Galante, Joseph M.; Tibbits, Emily M; Johnson, Nicholas J.; Carlbom, David; Mirhoseini, Mina F.; Patel, Mayur B.; O’Bosky, Karen R.; Chan, Christian; Udekwu, Pascal; Farrell, Mary Beth; Wild, Jeffrey; Young, Katelyn; Cullinane, Daniel C.; Gojmerac, Deborah J.; Weissman, Alexandra; Callaway, Clifton; Perman, Sarah M.; Guerrero, Mariana; Aisiku, Imoigele P.; Seethala, Raghu R.; Co, Ivan; Madhok, Debbie Y; Darger, Bryan; Kim, Dennis Y.; Spence, Lara H.; Scalea, Thomas M.; Stein, Deborah M.

doi:10.1097/ta.0000000000001945

Cited by 15 publications

(17 citation statements)

References 49 publications

(54 reference statements)

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“…Classification and Regression Tree is a form of machine learning that uses a given set of variables to create validated hierarchical decision trees, which has been applied in a range of disciplines, including in studies of trauma patients. [15][16][17] This method was chosen given its utility in determining both variable importance and the optimal cutoff values for each variable for predicting outcome. 15 To determine optimal splits in our predictor variables, the Gini coefficient was used, and cost complexity pruning was performed to prevent overfitting and build the most efficient decision tree.…”

Section: Statistical Analysesmentioning

confidence: 99%

Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study

Matthay¹,

Hellmann²,

Callcut³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Despite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era. METHODS:An Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014)(2015)(2016)(2017)(2018)(2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality. RESULTS:The 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, −9), and transfused a median of 29 U of RBCs, 22 U of fresh frozen plasma (FFP), and 24 U of platelets (PLT). Mortality was 46% at 24 hours and 65% at discharge. Transfusion of RBC/FFP ≥1.5:1 or RBC/PLT ≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC/PLT and RBC/FFP ≥1.5:1 (odds ratios, 3.11 and 2.81 for mortality at 24 hours and discharge; both p < 0.01). Classification and Regression Tree identified that age older than 50 years, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14-26%), while absence of these factors was associated with the highest survival (71%). CONCLUSION:Despite modern massive transfusion protocols, one half of trauma patients receiving UMT are transfused with either RBC/FFP or RBC/PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during UMT is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can aid in prognostication.

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Section: Statistical Analysesmentioning

confidence: 99%

Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study

Matthay¹,

Hellmann²,

Callcut³

et al. 2021

J Trauma Acute Care Surg

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“…However, recent studies reported that TTM was not associated with favorable neurological outcomes in patients with PCAS by hanging 12 . A multicenter retrospective study reported that TTM worsened the unadjusted survival and neurological outcomes; however, the possibility of selection bias was suggested 13 . To date, no randomized control trials have been conducted on TTM in patients with PCAS by hanging.…”

Section: Discussionmentioning

confidence: 99%

Effects of Targeted Temperature Management in Patients with Post-Cardiac Arrest Syndrome after an Out-Of-Hospital Cardiac Arrest Caused by Hanging: A Prospective Observational Cohort Study in Japan

Kakizaki

Bunya

Uemura

et al. 2021

Preprint

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Background: Targeted temperature management (TTM) is recommended for unconscious patients after a cardiac arrest. However, its effectiveness in patients with post-cardiac arrest syndrome (PCAS) by hanging remains unclear. Therefore, this study aimed to investigate the relationship between TTM and favorable neurological outcomes in patients with PCAS by hanging.Methods: This study was a retrospective analysis of the Japanese Association for Acute Medicine out-of-hospital cardiac arrest (OHCA) registry between June 2014 and December 2017 among patients with PCAS admitted to the hospitals after an OHCA caused by hanging. A multivariate logistic regression analysis was performed to estimate the propensity score and to predict whether patients with PCAS by hanging receive TTM. We compared patients with PCAS by hanging who received TTM (TTM group) and those who did not (non-TTM group) using propensity score analysis.Results: A total of 199 patients with PCAS by hanging were enrolled in this study. Among them, 43 were assigned to the TTM group and 156 to the non-TTM group. Logistic regression model adjusted for propensity score revealed that TTM was not associated with favorable neurological outcome at 1-month (adjusted odds ratio [OR]: 1.38, 95% confidence interval [CI]: 0.27–6.96). Moreover, no difference was observed in the propensity score-matched cohort (adjusted OR: 0, 73, 95% CI: 0.10–4.71) and in the inverse probability of treatment weighting-matched cohort (adjusted OR: 0.63, 95% CI: 0.15–2.69).Conclusions: TTM was not associated with increased favorable neurological outcomes at 1-month in patients with PCAS after OHCA by hanging.

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“…Factors similar to those affecting the risk of cardiac arrest may be involved in the substantial variability in reported hospital mortality rates, from about 10% to almost 80% 12,[16][17][18] . This variability contrasts sharply with the finding in most studies that about 10% of survivors had residual neurological impairments responsible for dependency 10,11,13,14,16,19 .…”

Section: Discussionmentioning

confidence: 99%

“…4 Importantly, cerebral anoxia may be related to cardiac arrest and/or to compression of the cervical blood vessels during hanging. 4,14 Cerebral imaging studies, when performed, have shown oedema, ischemia 10,13,[17][18][19][20][21] , and subarachnoid bleeding from cervical arteries. Subdural haematoma has been found in nearly one fourth of patients and usually ascribed to a head injury sustained during unhanging 17 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes in 886 Critically Ill Patients After Near-Hanging Injury

Charentenay

Schnell

Pichon

et al. 2020

Chest

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EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest

Abstract: Therapeutic study, level IV; prognostic study, level III.

Cited by 15 publications

References 49 publications

Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study

Outcomes after ultramassive transfusion in the modern era: An Eastern Association for the Surgery of Trauma multicenter study

Effects of Targeted Temperature Management in Patients with Post-Cardiac Arrest Syndrome after an Out-Of-Hospital Cardiac Arrest Caused by Hanging: A Prospective Observational Cohort Study in Japan

Outcomes in 886 Critically Ill Patients After Near-Hanging Injury

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