Abstract
Purpose To review the literature on airway and respiratory management following non-lethal (suicidal) hanging and to describe the anatomy, mjury and pathophysiological sequelae and their impact on patient care. Source A Medline literature search of English-language and English-abstracted papers for 1990–96. Keywords were: hanging; strangulation; airway obstruction; pulmonary oedema. Fitters were applied to limit the search to relevant citations, (i.e., keywords = pulmonary oedema; filters = postobstructive, neurogenic). Citations were then hand-culled to obtain current and relevant papers about an unusual cohort of patients. A hand search of the bibliographies of relevant papers supplemented the Medline search. A review of our expenence at the University of Ottawa adult hospitals over the last decade was also undertaken to determine the relevance of the literature to our clinical expenences. Principal Findings Most victims are young men and survivors are uncommon. Laryngo-tracheal injunes, although reported in 20–50% of postmortem examinations, are infrequent in survivors and have little impact on airway management. Spinal injuries are rare in survivors but should be excluded. Pulmonary complications including pulmonary oedema and bronchopneumonia are implicated in most in-hosprtal deaths. Pulmonary oedema is likely due to neurogenic factors or negative intrathoracic pressure. Although neurological injury determines outcome following hanging, initial neurological presentation is of limited prognostic value: a poor initial condition does not exclude a good recovery. Conclusion Airway injuries severe enough to interfere with airway management are uncommon after attempted suicide by hanging. Irrespective of the initial neurological assessment, aggressive and early resuscitation to optimize cerebra oxygénation is recommended.