Clinical update: suspension trauma.

OBJECTIVE: Suspension trauma refers to the pathophysiologic syndrome that occurs when a victim is suspended motionless in a vertical position for an extended period of time. This can occur in sports that use a harness system as well as in various occupational activities including work on high wires or helicopter rescue operations. We reviewed the scientific evidence published to date in order to improve the prevention and treatment of suspension trauma.

METHODS: Medline, PreMedline, the Cochrane Library, and Google Scholar were searched for relevant information about suspension trauma.

RESULTS: Published data describing the pathophysiology of and the therapeutic approach to suspension trauma are sparse and consist mainly of case reports and a limited number of human experimental prospective studies. The pathophysiology of suspension trauma is related to hypovolemia induced by reduced venous return and by vagal stimulation. It is also influenced by the type of harness used. Chest harnesses may induce severe cardiorespiratory repercussions and have the lowest motionless suspension tolerance. Symptoms of suspension trauma include presyncope and can lead to a loss of consciousness.

CONCLUSIONS: Sports enthusiasts and workers who use a body harness system should never act alone and should not use a simple chest harness. If a victim shows symptoms of presyncope or is unconscious, he should be released from suspension as soon as is safely possible. There is no clear evidence to support the idea that the return to the horizontal position may contribute to the potential risk of rescue death.