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Therapeutic hypothermia for brain injury from near hanging: review of the literature.

Hanging, strangulation, and suffocation constitute the second most common cause of death by suicide in the United States after firearms. Near hanging is defined as an unsuccessful attempt at hanging. Victims of near hanging suffer from strangulation with cerebral ischemia and resultant reperfusion injury, irrespective of whether they had cardiac arrest or not. The acute post-injury period is characterized by several pathophysiologic processes that start in the minutes to hours following injury. All of these processes are temperature dependent; they are all aggravated by fever and inhibited by hypothermia. In this article, we review the current clinical evidence on the use of therapeutic hypothermia (TH) for comatose near-hanging patients. We identified seven studies involving TH for near hanging on 51 patients. All the studies are retrospective reviews or case reports. TH (32-33°C) was applied for 24-36 hours. Even though some studies showed that near-hanging victims who present comatose to the hospital can have good neurologic outcomes after supportive therapy alone, some patients are still left with a poor neurologic outcome, especially if they sustained cardiac arrest. Prospective studies are warranted to test the potential benefit of TH on neurologic outcome and survival in this patient population. Although it would be difficult to conduct such studies, we feel that the compelling case studies, anecdotal evidence, and extrapolated data support its use until more evidence can be obtained.