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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2023

Open Access 01-12-2023 | Emergency Medicine | Review

Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)

Authors: Simon Rauch, Raimund Lechner, Giacomo Strapazzon, Roger B. Mortimer, John Ellerton, Sven Christjar Skaiaa, Tobias Huber, Hermann Brugger, Mathieu Pasquier, Peter Paal

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2023

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Abstract

Background

Suspension syndrome describes a multifactorial cardio-circulatory collapse during passive hanging on a rope or in a harness system in a vertical or near-vertical position. The pathophysiology is still debated controversially.

Aims

The International Commission for Mountain Emergency Medicine (ICAR MedCom) performed a scoping review to identify all articles with original epidemiological and medical data to understand the pathophysiology of suspension syndrome and develop updated recommendations for the definition, prevention, and management of suspension syndrome.

Methods

A literature search was performed in PubMed, Embase, Web of Science and the Cochrane library. The bibliographies of the eligible articles for this review were additionally screened.

Results

The online literature search yielded 210 articles, scanning of the references yielded another 30 articles. Finally, 23 articles were included into this work.

Conclusions

Suspension Syndrome is a rare entity. A neurocardiogenic reflex may lead to bradycardia, arterial hypotension, loss of consciousness and cardiac arrest. Concomitant causes, such as pain from being suspended, traumatic injuries and accidental hypothermia may contribute to the development of the Suspension Syndrome. Preventive factors include using a well-fitting sit harness, which does not cause discomfort while being suspended, and activating the muscle pump of the legs. Expediting help to extricate the suspended person is key. In a peri-arrest situation, the person should be positioned supine and standard advanced life support should be initiated immediately. Reversible causes of cardiac arrest caused or aggravated by suspension syndrome, e.g., hyperkalaemia, pulmonary embolism, hypoxia, and hypothermia, should be considered. In the hospital, blood and further exams should assess organ injuries caused by suspension syndrome.
Literature
1.
Pasquier M, Yersin B, Vallotton L, Carron PN. Clinical update: suspension trauma. Wilderness Environ Med. 2011;22(2):167–71.CrossRefPubMed
2.
Flora G, Holzl H. Fatal and non-fatal accidents involving falls into the rope. Paper of the Second International Conference of Mountain Rescue Doctors, Innsbruck (Austria) 1972.
3.
Mortimer RB. Risks and management of prolonged suspension in an Alpine harness. Wilderness Environ Med. 2011;22(1):77–86.CrossRefPubMed
4.
Seddon P. Harness suspension: review and evaluation of existing information. Norwich: Health and Safety Executive 2002.
5.
Amphoux M, editor Hanging after a fall: an extremely urgent rescue1998; Wuppertal, Germany.
6.
Patscheider H. Pathologico-anatomical examination results in the case of death caused by hanging on the rope. Paper of the Second International Conference of Mountain Rescue Doctors, Innsbruck (Austria) 1972.
7.
Wharton DR, Mortimer RB. Rhabdomyolysis after prolonged suspension in a cave. Wilderness Environ Med. 2011;22(1):52–3.CrossRefPubMed
8.
9.
Adisesh A, Lee C, Porter K. Harness suspension and first aid management: development of an evidence-based guideline. Emerg Med J. 2011;28(4):265–8.CrossRefPubMed
10.
Lanfranconi F, Pollastri L, Corna G, Bartesaghi M, Novarina M, Ferri A, et al. The elusive path of brain tissue oxygenation and cerebral perfusion in harness hang syncope in mountain climbers. High Alt Med Biol. 2017;18(4):363–71.CrossRefPubMed
11.
Rauch S, Schenk K, Strapazzon G, Dal Cappello T, Gatterer H, Palma M, et al. Suspension syndrome: a potentially fatal vagally mediated circulatory collapse—an experimental randomized crossover trial. Eur J Appl Physiol. 2019.
12.
Raynovich B, Rwaili FT, Bishop P. Dangerous suspension. Understanding suspension syndrome & prehospital treatment for those at risk. JEMS: J Emerg Med Serv. 2009;34(8):44–51, 3; quiz 3.
13.
Drew R. Suspension trauma. Can J Emerg Nurs. 2020.
14.
Petrone P, Espinoza-Villalobos S, Baltazar GA, Søreide K, Stright A, Brathwaite CEM, et al. Fatal and non-fatal injuries due to suspension trauma syndrome: a systematic review of definition, pathophysiology, and management controversies. World J Emerg Med. 2021;12(4):253–60.CrossRefPubMedPubMedCentral
15.
Flora GM, R.; Dittrich, P.; Stuhlinger, W. Hanging tests—conclusions for the mountaineer. Paper of the Second International Conference of Mountain Rescue Doctors (Austria) German to English translation by HSE Language Services Transl No 16372(I)1972.
16.
17.
Pasquier M, Strapazzon G, Kottmann A, Paal P, Zafren K, Oshiro K, et al. On-site treatment of avalanche victims: scoping review and 2023 recommendations of the international commission for mountain emergency medicine (ICAR MedCom). Resuscitation. 2023;184:109708.CrossRefPubMed
18.
Blancher M, Albasini F, Elsensohn F, Zafren K, Hölzl N, McLaughlin K, et al. Management of multi-casualty incidents in mountain rescue: evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM). High Alt Med Biol. 2018;19(2):131–40.CrossRefPubMedPubMedCentral
19.
Sumann G, Moens D, Brink B, Brodmann Maeder M, Greene M, Jacob M, et al. Multiple trauma management in mountain environments - a scoping review: evidence based guidelines of the International Commission for Mountain Emergency Medicine (ICAR MedCom). Intended for physicians and other advanced life support personnel. Scand J Trauma Resuscitation Emerg Med. 2020;28(1):117.
20.
Roy S, Soteras I, Sheets A, Price R, Oshiro K, Rauch S, et al. Guidelines for mountain rescue during the COVID-19 pandemic: official guidelines of the international commission for alpine rescue. High Alt Med Biol. 2021;22(2):128–41.CrossRefPubMedPubMedCentral
21.
Lugnet V, McDonough M, Gordon L, Galindez M, Mena Reyes N, Sheets A, et al. Termination of cardiopulmonary resuscitation in mountain rescue: a scoping review and ICAR MedCom 2023 recommendations. High Alt Med Biol. 2023.
22.
Ellerton J, Milani M, Blancher M, Zen-Ruffinen G, Skaiaa SC, Brink B, et al. Managing moderate and severe pain in mountain rescue. High Alt Med Biol. 2014;15(1):8–14.CrossRefPubMed
23.
Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest. 2006;129(1):174–81.CrossRefPubMed
24.
Stuhlinger WD, P; Flora, G; Margreiter, R. Circulatory and renal function changes in test subjects suspended from the upper half of the body. Paper of the Second International Conference of Mountain Rescue Doctors, Innsbruck (Austria) 1972.
25.
Orzech M GM, Brickley J, Salerno M, Seaworth J. test program to evaluate human response to prolonged motionless suspension in three types of fall protection harnesses. . In: Armstrong Aerospace Medical Research Laboratory W-PAFB, editor. 1987.
26.
Roeggla M, Brunner M, Michalek A, Gamper G, Marschall I, Hirschl MM, et al. Cardiorespiratory response to free suspension simulating the situation between fall and rescue in a rock climbing accident. Wilderness Environ Med. 1996;7(2):109–14.CrossRefPubMed
27.
Madsen P, Svendsen LB, Jørgensen LG, Matzen S, Jansen E, Secher NH. Tolerance to head-up tilt and suspension with elevated legs. Aviat Space Environ Med. 1998;69(8):781–4.PubMed
28.
Shamsuzzaman AS, Sugiyama Y, Kamiya A, Fu Q, Mano T. Head-up suspension in humans: effects on sympathetic vasomotor activity and cardiovascular responses. J Appl Physiol (Bethesda, Md : 1985). 1998;84(5):1513–9.
29.
Rollnik JD, Witt K, Hänert W, Rix W, Schwindt M. Rescue lifting system (RLS) might help to prevent death after rescue from immersion in cold water. Int J Sports Med. 2001;22(1):17–20.CrossRefPubMed
30.
Pisati G, Cerri S, Achille G, Rossi G, Lorenzi G. Vascular thrombosis and pulmonary thrombo-embolism due to harness suspension. Med Lav. 2007;98(5):415–21.PubMed
31.
Turner NL, Wassell JT, Whisler R, Zwiener J. Suspension tolerance in a full-body safety harness, and a prototype harness accessory. J Occup Environ Hyg. 2008;5(4):227–31.CrossRefPubMed
32.
Ruhrmann S, Lutz M, Uhle F, Rehmann H, Haverney F, Weigand M, et al. Medizinische Versorgung in der Höhenrettung. Notfall + Rettungsmedizin. 2010;13(6):458–64.
33.
34.
35.
Goossens L, Vander Laenen M, Boer W. Abstracts presented at the fifth symposium of the Belgian Society of Emergency and Disaster Medicine (BESEDIM); Abstract Nr: 24 Hanging by a thread. Acta Clin Belg. 2014;69(sup1):S1–34.CrossRef
36.
Beverly JM, Zuhl MN, White JMB, Beverly ER, VanDusseldorp TA, McCormick JJ, et al. Harness suspension stress: physiological and safety assessment. J Occup Environ Med. 2019;61(1):35–40.CrossRefPubMed
37.
Lanfranconi F, Ferri A, Pollastri L, Bartesaghi M, Novarina M, De Vito G, et al. Impact of hanging motionless in harness on respiratory and blood pressure reflex modulation in mountain climbers. High Alt Med Biol. 2019;20(2):122–32.CrossRefPubMedPubMedCentral
38.
Rauch S, Schenk K, Gatterer H, Erckert M, Oberhuber L, Bliemsrieder B, et al. Venous pooling in suspension syndrome assessed with ultrasound. Wilderness Environ Med. 2020;31(2):204–8.CrossRefPubMed
39.
Baszczyński K. Effect of safety harness design on the pressures exerted on the user’s body in the state of its suspension. Int J Occup Saf Ergon. 2022;28(3):1894–903.CrossRefPubMed
40.
Mosqueda-Garcia R, Furlan R, Tank J, Fernandez-Violante R. The elusive pathophysiology of neurally mediated syncope. Circulation. 2000;102(23):2898–906.CrossRefPubMed
41.
Chen-Scarabelli C, Scarabelli TM. Neurocardiogenic syncope. BMJ (Clin Res ed). 2004;329(7461):336–41.CrossRef
42.
Kolb JJ, Smith EL. SUSPENSION SHOCK. Redefining the diagnosis and treatment of suspension trauma. JEMS: J Emerg Med Serv. 2015;40(6):48–51.
43.
Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, et al. European resuscitation council guidelines 2021: adult advanced life support. Resuscitation. 2021;161:115–51.CrossRefPubMed
44.
Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219.CrossRefPubMed
45.
Thomassen O, Skaiaa SC, Brattebo G, Heltne JK, Dahlberg T, Sunde GA. Does the horizontal position increase risk of rescue death following suspension trauma? Emerg Med J. 2009;26(12):896–8.CrossRefPubMed
46.
Adisesh A RL, Codling A, Harris-Roberts J, Lee C, Porter K. Evidence-based review of the current guidance on first aid measures for suspension trauma. . In: Executive HaS, editor. Norwich, UK; 2009.
47.
48.
Fitzgibbon JB, Lovallo E, Escajeda J, Radomski MA, Martin-Gill C. Feasibility of out-of-hospital cardiac arrest ultrasound by ems physicians. Prehosp Emerg Care. 2019;23(3):297–303.CrossRefPubMed
49.
Robinson AE, Simpson NS, Hick JL, Moore JC, Jones GA, Fischer MD, et al. Prehospital ultrasound diagnosis of massive pulmonary embolism by non-physicians: a case series. Prehosp Emerg Care. 2022:1–6.
50.
Scharonow M, Weilbach C. Prehospital point-of-care emergency ultrasound: a cohort study. Scand J Trauma Resuscitation Emerg Med. 2018;26(1):49.CrossRef
51.
Mortimer RB, Zafren K. Evidence-based versus myth-based treatment of suspension syndrome. Wilderness Environ Med. 2020;31(2):202–3.CrossRefPubMed
Metadata
Title
Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
Authors
Simon Rauch
Raimund Lechner
Giacomo Strapazzon
Roger B. Mortimer
John Ellerton
Sven Christjar Skaiaa
Tobias Huber
Hermann Brugger
Mathieu Pasquier
Peter Paal
Publication date
01-12-2023
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-023-01164-z

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