Near hanging

Abstract

Objectives: To review the literature on near hanging, focusing on the pathophysiology, and relating this to the clinical features and management. Methods: English language articles published in the past 15 years and major textbooks of emergency and forensic medicine were searched. Eight case series and six relevant single case reports were identified. Only articles concerned with non‐judicial near hanging were reviewed. Data concerning the incidence of cervical spine injury, laryngeal injury, pulmonary complications and mortality were extracted. Not the case series documented the presence or absence of all these factors, resulting in differing total patient numbers in each category. Unusual complications of near hanging were documented from case reports. Results: Cervical spine injury occurred in four of 689 patients (0.6%). Pulmonary complications occurred in 15 of 133 patients (11%). The in‐hospital mortality rate was 23% (29 deaths of 128). No clinically significant laryngeal injuries were reported. Unusual complications documented included hyperthermia, status epilepticus, carotid artery dissection, subarachnoid haemorrhage and pneumoperitoneum. Conclusions: Cervical spine injury, although uncommon, does occur in near hanging, and emergent airway management should take this into account. Laryngeal injury sufficiently severe to interfere with endotracheal intubation does not appear to occur. Cerebral oedema, aspiration pneumonia and acute respiratory distress syndrome are the commonest in‐hospital complications. Management of near hanging involves establishment of a safe airway, plus treatment of pulmonary and cerebral oedema along standard lines. In‐hospital mortality remains high.

Can clinical variables at admission influence the outcome in patients with suicidal hanging: a prospective study

“…10 The pathophysiological basis of adverse outcome in hanging has been attributed to various factors like cerebral hypoxia, laryngeal oedema, airway obstruction, high vagal tone secondary to carotid sinus stimulation injuries secondary to local structures like thyroid cartilage/hyoid bone fracture/laryngeal rupture, secondary pulmonary complications (aspiration pneumonia, development of adult respiratory distress, negative pressure, pulmonary oedema or secondary cerebral injury due to cerebral oedema etc. 6,7 As in every other study, majority of patients who attempt suicidal hanging are invariably male and young, the same pattern continues in our study also. Out of forty patients, 27 (67.5%) patients belonged to male gender and twenty patients (50%) belong to age group (in both sexes) of twenty one to thirty years.…”

“…5 The term near hanging is reserved for victims who have survived the hanging injury and reaches the hospital. 6,7 Death in suicidal hanging usually results from asphyxial cerebral injury which is different from judicial hanging where death occurs due to cervical spine injury. 8 Mechanism of asphyxia is considered to be because of stagnant hypoxia resulting from jugular venous obstruction due to compression of the soft tissues of the neck.…”

“C3, 4, 5 Keeps the Diaphragm Alive.” Is Phrenic Nerve Palsy Part of the Pathophysiological Mechanism in Strangulation and Hanging? Should Diaphragm Paralysis be Excluded in Survived Cases?

“…Scientific articles addressing findings in survived neck compression make no mention of this possible pathophysiological mechanism, either to confirm or refute its existence. [21][22][23][24][25][26][27][28] Whether this is because it has never occurred, or because dyspnoea following an episode of neck compression is attributed to some other cause related to airway occlusion, such as mass affect from localized edema, cannot be known. However, respiratory symptoms and signs, including hyperventilation and pneumonia, have been documented in survived neck compression.…”

“…However, respiratory symptoms and signs, including hyperventilation and pneumonia, have been documented in survived neck compression. 21,22,25,27 …”

The hanging/hanged patient and relevance to pre-hospital care

“…Death from hanging (judicial or non-judicial) can be cause by a number of reasons, strangulation, carotid/vagal reflex or fracturing the cervical spine causing severe damage to the spinal cord (CapitalPunishmentUK.org undated). 'Hanging' by definition results in the death of the individual, however, 'Near hanging' differs in that the individual survives to admission to hospital (Adams 1999).…”