AIRWAY AND RESPIRATORY MANAGEMENT FOLLOWING NONLETHAL HANGING

Purpose: To review the literature on airway and respiratory management following non-lethal (suicidal) hanging and to describe the anatomy, injury and pathophysiological sequelae and their impact on patient car e. Source: A Medline literature search of English-language and English -abstracted papers for 1990-96. Keywords were: hanging; strangulation; airway obstruction; pulmonary oedema. Filters were applied to limit t he search to relevant citations. (i.e., keywords = pulmonary oedema; f ilters = postobstructive, neurogenic). Citations were then hand-culled to obtain current and relevant papers about an unusual cohort of pati ents. A hand search of the bibliographies of relevant papers supplemen ted the Medline search. A review of our experience at the University o f Ottawa adult hospitals over the last decade was also undertaken to d etermine the relevance of the literature to our clinical experiences. Principal Findings: Most victims are young men and survivors are uncom mon. Laryngo-tracheal injuries, although reported in 20-50% of postmor tem examinations, are infrequent in survivors and have little impact o n airway management. Spinal injuries are rare in survivors but should be excluded. Pulmonary complications including pulmonary oedema and br onchopneumonia are implicated in most in-hospital deaths. Pulmonary oe dema is likely due to neurogenic factors or negative intrathoracic pre ssure. Although neurological injury determines outcome following hangi ng, 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 init ial neurological assessment, aggressive and early resuscitation to opt imize cerebral oxygenation is recommended.