Suspension syndrome

Suspension syndrome is a potentially fatal event of unknown incidence that can be caused by motionless hanging in the rope during rope-secured activities. During prolonged hanging, generalized hypoperfusion with reduced cerebral blood flow and consecutive loss of consciousness occurs. Two mechanisms are discussed as the cause leading to loss of consciousness: venous pooling in the legs and a sudden reduction of heart rate and blood pressure, similar to a neurocardiogenic syncope. The most important preventive measure is the activation of the muscle pump during hanging. In principle, the treatment follows standard ABCDE care. The patient should be rescued from the hanging position as fast as possible and airway obstruction caused by hyperflexion of the head during unconscious hanging has to be reversed. There is an increased risk of hyperkalemia. Therefore, ECG monitoring should be established as soon as possible to recognize cardiac arrhythmias. Pulmonary embolism should be considered as a potentially reversible cause of cardiac arrest. Hypothermia prophylaxis and treatment have high priority. For suspension longer than two hours, a medical treatment facility able to provide continuous renal replacement therapy should be chosen. There is no evidence that laying a patient flat immediately after rescue is harmful. Key Words: Neurocardiac Syncope, Venous Pooling, Rescue Death, Generalized Hypoperfusion, Standard ABCDE Care