Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
ICAR MedCom (seat Zurich) · 2023 · Switzerland
Source and licence
- Authors
- Simon Rauch, Raimund Lechner, Giacomo Strapazzon et al.
- Title
- Suspension syndrome: a scoping review and recommendations from the International Commission for Mountain Emergency Medicine (ICAR MEDCOM)
- Journal
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10710713
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Recommendations
- 1Rope work should be done only with proper equipment and knowledge on how to use it correctly. Rope work should never be conducted aloneGrade: 1C
- 2Persons suspended in a harness should be rescued as soon as possible, even if the casualty is asymptomatic, as time to near or actual syncope and potentially cardiac arrest is variable and unpredictable [11]Grade: 1B
- 3While awaiting rescue, persons suspended freely on a rope should move their legs to reduce venous pooling [11, 38]Grade: 2B
- 4If no adjoining structures are in reach, foot loops should be used to step in and increase the activation of the muscle pump [1, 3, 11, 42]Grade: 2B
- 5If the casualty is no longer able to act and it is safe to do so, the first rescuer reaching the casualty should raise the victim’s legs to create a more horizontal position while measures are taken to lower the patient to the ground [11, 42]Grade: 2C
- 6Once the casualty is on the ground, the casualty should be positioned supine. Assessment and treatment should follow standard advanced life support algorithms. Reversible causes of cardiac arrest, including hyperkalaemia and pulmonary embolism, should be considered, and managed appropriately [1, 3, 11, 42, 43, 45, 46]Grade: 1A
- 7After prolonged hanging (> 2 h), patients are at risk of developing hyperkalaemia and acute kidney injury and should therefore be transported to a hospital with the capability of performing emergent renal replacement therapy [2, 3, 7]Grade: 2C
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.
Contents of the original publication
The section headings of the original.
- Background
- Methods
- Results
- Literature search
- Description of studies
- Discussion
- Definitions and classification
- Diagnosis and treatment
- Prevention
- Research implications
- Limitations
- Conclusions
- Recommendations
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