Near-hanging injury in childhood: a literature review and report of three cases.

Near-hanging injury is not an uncommon occurrence in children. Surprisingly, little discussion of this topic occurs in the pediatric literature. Previous reports note that children who present with an initial pH less than 7.2, apnea or agonal respiration, or who subsequently require mechanical ventilation, either die or survive with severe neurologic residua. We report a series of three pediatric patients aged 12 years or younger who initially presented with a combination of the above morbid criteria, all of whom survived with good neurologic outcomes. Children who suffer significant near-hanging injury should be considered at high risk to develop cerebral edema and therefore should be managed aggressively. Early cardiopulmonary resuscitation in the field is essential to reestablish cerebral blood flow. A good response to initial resuscitation is an important prognostic factor for eventual recovery. After arrival to the emergency department, therapy should include controlled hyperventilation, fluid restriction, and other supportive measures to limit intracranial pressure in high-risk patients.