Table 1 Articles included for analysis
Author | Year | Study design | Sample Size | Key findings | Quality assessment |
|---|---|---|---|---|---|
Patscheider [6] | 1972 | Observational autopsy study | 5 (climbers died in the Tyrolean alps between 1957 – 1968) | Hypoxic changes of heart, liver and in one case kidney Protracted orthostatic shock is the cause of organ injury | Fair |
Flora et al. [15] | 1972 | Summary of results from physiological experimental human studies with chest harness suspension presented at the 2nd international Conference of Mountain Rescue physicians (original articles are not available) | Massive circulatory obstruction Increase of heart rate and reduction of pulse pressure Reduction of blood pressure Drop of central venous pressure Reduction of renal function ECG changes Presyncopal syndroms in subjects | Poor | |
Flora et al. [2] | 1972 | Case series with pathophysiologic parameters | 23 (10 died, 13 survived) | Reported pathophysiological conditions: acute kidney injury, hypoxic heart muscle damage, muscle necrosis and dyspnoea Arm plexus damage in chest harness after 10 to 20 min of free suspension, if no foot loops were used Death occurred regularly after suspension longer than two hours | Fair |
Stuehlinger et al. [24] | 1972 | Observational physiologic human study | 10, two trial runs | Hanging in a chest harness was aborted after 8 to 22 min due to pallor, cold sweat, nausea and paraesthesia in the upper extremities Hanging in a sit harness was aborted in 3 cases after 22 to 28 min due to clinical symptoms Tachycardia and hypertension due to sympathetic activation Indirect signs of peripheral blood pooling Sinus arrythmia and extrasystoles after placement in horizontal position after trial, which led to the assumption of sudden cardiac arrest due to horizontal placement after hanging Glomerular filtration and renal plasma flow drops already after only 8 min, with further drop while hanging | Fair |
Orzech et al. [25] | 1987 | Observational physiologic human study and review | 13 (each with body belt, chest harness, full body harness) | Suspension tolerance in a body belt or chest harness alone is significantly lower than in a full body harness, due to pain and difficulty of breathing during hanging | Fair |
Roeggla et al. [26] | 1996 | Observational physiologic human study | 6 (each with chest harness alone or sit harness) | Decrease of vital capacity, forced expiratory volume and cardiac output in chest harness suspension | Good |
Madsen et al. [27] | 1998 | Observational physiologic human study | 9 knee strap suspension 79 50° head up tilt table | 11% developed symptoms with knee strap, 87% developed symptoms with 50° head up tilt Longer tolerance of suspension with support strap under knees due to preserved venous return Initial heart rate and blood pressure increase followed by a drop with onset of presyncopal symptoms Reduction of central blood volume during head up tilt | Fair |
Shamsuzzaman et al. [28] | 1998 | Observational physiologic human study | 13 (each on tilt table and tilted suspension) | One vasovagal reaction during “suspension” Engagement of antigravity muscles have effects on sympathetic vasoconstriction and cardiovascular responses During suspension reduction of cardiac output and stroke volume, tachycardia and hypertension | Good |
Rollnik et al. [29] | 2001 | Observational physiologic human study | 14 | Suspension in supine position (one sling around the thorax and one sling around the thighs) caused only moderate heart rate changes, which were significantly lower compared to vertical suspension Vertical suspension with a sling placed under the armpits was tolerated only 2—4 min | Fair |
Seddon et al. [4] | 2002 | National survey | Not applicable | No suspension syndrome within 5.8 million on-rope hours by rope access technicians qualified by IRATA (International Rope Access Trade Association) | Fair |
Pisati et al. [30] | 2007 | Case report with discussion of pathophysiologic parameters | 2 | Prolonged hanging in a sit harness caused pulmonary thrombo-embolism and thrombosis of femoral artery, most likely due to compression by harness groin straps | Poor |
Turner et al. [31] | 2008 | Observational physiologic human study | 40 (each on front and back attachment) 28 (harness with leg support for a more horizontal suspension position) | Harness with leg support doubled suspension time Body weight reduced suspension time with back attachment | Good |
Ruhrmann et al. [32] | 2010 | National survey among height rescue organizations | 68 questionnaires | 3 cases of suspension syndrome in 131 datasets | Poor |
Wharton et al. [7] | 2011 | Case report with pathophysiologic parameters | 1 | Suspension > 4 h Rhabdomyolysis and acute kidney injruy | Poor |
Hsiao et al. [33] | 2012 | Observational physiologic human study | 37 | Suspension tolerance between 5 and 56 min Static harness fit does not correlate with suspension tolerance Improperly conformed / sized harness could increase risk of suspension syndrome Rear attachment with angle > 35° between torso and suspension line has shorter suspension time | Good |
Hsiao et al. [34] | 2013 | Observational physiologic human study and Fourier analysis of torso scans | 216 | different harness sizes are necessary for optimal fit Harness fit is partly dependent on gender Harness adjustment is necessary for clothing and other equipment | Good |
Goossens et al. [35] | 2014 | Case report | 1 | Combination of heat stroke and suspension syndrome after 1 h of suspension Unconsciousness, rhabdomyolysis, and acute kidney injury | Poor |
Lanfranconi et al. [10] | 2017 | Observational physiologic human study | 40 | Syncope in 10% with drop of systolic blood pressure, tachycardia just before syncope and bradycardia during recovery Onset of syncope from aprupt to minutes after first clinical signs Decrease of cerebral oxygenated hemoglobin before syncope | Good |
Beverly et al. [36] | 2019 | Observational physiologic human study | 18, with two trial runs | Tolerance of rear attachment hanging is significantly lower than front attachment (shorter duration of hanging, more trial terminations) 25% suffered symptoms which lead to trial termination, one near syncope Bradycardia in three subjects who terminated trial early Weak laboratory signs of muscle damage with dorsal attachment (significant aspartate aminotransferase increase) | Fair |
Lanfranconi et al. [37] | 2019 | Observational physiologic human study | 40 | Syncope in 10% with decrease of arterial oxygen saturation and a drop of systolic blood pressure Short suspension tolerance participants (no syncope) had a changed of breathing pattern (increase of tidal volume, decrease of frequency, increase in respiratory elastic power) stress induced hypertension (sympathetic activation) | Good |
Rauch et al. [11] | 2019 | Observational physiologic human study | 20 | Sudden pre-syncope in 30% Vagal mechanism leads to loss of consciousness (bradycardia and drop in systolic blood pressure) Time to pre-syncope is unpredictable | Good |
Rauch et al. [38] | 2019 | Observational physiologic human study | 20 | Free hanging leads to rapid venous pooling in the limbs Most important preventive measure might be constant leg movement Pulmonary embolism might be preventable cause of death | Good |
Baszczynski [39] | 2022 | Observational manikin study | 4 industrial climbing harnesses | Industrial climbing harnesses, especially with rear attachment, have a high risk of excessive local pressure | Poor |