Near Hanging: evaluation and management.

ABSTRACT

Prior to the COVID-19 pandemic, the incidence of self-harm was already on the rise. Hanging/suffocation accounted for 50% of the increase in suicide attempts and remains the second leading cause of death from self-harm in the United States. Studies on the management of near hanging patients are lacking and most published literature is retrospective. Following airway and circulation assessment, clinical examination and imaging, namely CT angiography, remain the standard to identify the injuries associated with near hanging - cervical spine fracture, blunt cerebrovascular injury, laryngeal injury, injury to the trachea and oropharynx. These injuries, however, are uncommon, and each occur in less than 5% of patients in most series. In a large series of critically ill near hanging patients, over 50% survived to hospital discharge, however cardiac arrest predicted a poor outcome. The management of asphyxia related arrest remains controversial. Targeted Temperature Management (TTM) has only been studied in a single large multicenter trial which was retrospective. Given the significant selection bias of TTM treatment for the most ill patients, no firm recommendations can be made. Finally, for survivors, the underlaying mental health issues must be addressed to avoid recurrent suicide attempts. Thirty percent of patients in a large near hanging series were admitted for their second suicide attempt.