Successful therapeutic hypothermia for children surviving near-hanging

A Child With a Glasgow Coma Scale Score of 4 After Near-Hanging: A Case Report on Treatment Without Intubation and Targeted Temperature Management

While prehospital medical interventions are evolving and improving survival rates, the evidence for adequate early prognostic assessment is often insufficient. A 12-year-old Japanese child was found hanging on the roof of his home. After being rescued by his mother, he was transported by an ambulance and a rapid response car (RRC) with doctors, nurses, and paramedics on board, and admitted to our hospital. His initial Glasgow Coma Scale score in the RRC was 4. Although he did not undergo intubation and targeted temperature management (TTM), he had no neurological sequelae upon discharge. To the best of our knowledge, this report is the first to describe the case of a child with a decreased level of consciousness after near-hanging, who was treated without intubation and TTM.

Accidental hanging injuries in children: recognition and management

Accidental hanging is rare in childhood but is often fatal. Window blind cords pose a particular and unique risk to young children in the UK, accounting for one to two deaths annually. These accidents are frequently associated with non-adherence to the safety instructions provided by the manufacturers. Early discovery of the child and initiation of effective cardiopulmonary resuscitation at the site of the incident are likely to improve the outcome. Prolonged suspension, children who are pulseless at first contact by the emergency paramedic responder, and patients with prolonged periods of remaining in asystole before return of spontaneous circulation after starting cardiopulmonary resuscitation are unlikely to have intact neurological survival. Management in the hospital includes early airway protection by intubation, maintenance of normal oxygen saturation, normothermia, active control of clinical and sub-clinical seizures, and strict electrolyte and glucose regulation. Child safeguarding concerns should be considered when children have asphyxial injuries, and other signs of child physical abuse should be actively looked for. There is a need for stronger legislation in the UK to prevent some of these accidents, especially those relating to window blind cords.