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Asphyxia or asphyxiation is a condition of deficient supply of
oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
to the
body Body may refer to: In science * Physical body, an object in physics that represents a large amount, has mass or takes up space * Body (biology), the physical material of an organism * Body plan, the physical features shared by a group of anima ...
which arises from abnormal
breathing Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellular ...
. Asphyxia causes
generalized hypoxia Generalized hypoxia is a medical condition in which the tissues of the body are deprived of the necessary levels of oxygen due to an insufficient supply of oxygen, which may be due to the composition or pressure of the breathing gas, decreased lu ...
, which affects primarily the tissues and organs. There are many circumstances that can induce asphyxia, all of which are characterized by the inability of a person to acquire sufficient oxygen through breathing for an extended period of time. Asphyxia can cause coma or death. In 2015, about 9.8 million cases of unintentional suffocation occurred which resulted in 35,600 deaths. The word asphyxia is from
Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...
"without" and , "squeeze" (throb of heart).


Causes

Situations that can cause asphyxia include but are not limited to:
airway obstruction Airway obstruction is a blockage of respiration in the airway that hinders the free flow of air. It can be broadly classified into being either in the upper airway (UPA) or lower airway (LOA). Airway obstruction is a life-threatening condition ...
, the constriction or obstruction of airways, such as from
asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, cou ...
,
laryngospasm Laryngospasm is an uncontrolled or involuntary muscular contraction (spasm) of the vocal folds. The condition typically lasts less than 60 seconds, but in cases partial blocking it may last 20 to 30 minutes and hinder inspiration, while exhala ...
, or simple blockage from the presence of foreign materials; from being in environments where oxygen is not readily accessible: such as underwater, in a low oxygen atmosphere, or in a vacuum; environments where sufficiently oxygenated air is present, but cannot be adequately breathed because of air contamination such as excessive smoke. Other causes of oxygen deficiency include but are not limited to: *
Acute respiratory distress syndrome Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. Symptoms include shortness of breath (dyspnea), rapid breathing (tachypnea), and bluish skin colo ...
* Carbon monoxide inhalation, such as that from a car exhaust and the smoke's emission from a lit
cigarette A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhaled via the opp ...
: carbon monoxide has a higher affinity than oxygen to the
hemoglobin Hemoglobin (haemoglobin BrE) (from the Greek word αἷμα, ''haîma'' 'blood' + Latin ''globus'' 'ball, sphere' + ''-in'') (), abbreviated Hb or Hgb, is the iron-containing oxygen-transport metalloprotein present in red blood cells (erythrocyte ...
in the blood's red blood corpuscles, bonding with it tenaciously, and, in the process, displacing oxygen and preventing the blood from transporting oxygen around the body * Contact with certain chemicals, including
pulmonary agent A pulmonary agent, or choking agent, is a chemical weapon agent designed to impede a victim's ability to breathe. They operate by causing a build-up of fluids in the lungs, which then leads to suffocation. Exposure to the eyes and skin tends to ...
s (such as
phosgene Phosgene is the organic chemical compound with the formula COCl2. It is a toxic, colorless gas; in low concentrations, its musty odor resembles that of freshly cut hay or grass. Phosgene is a valued and important industrial building block, espe ...
) and
blood agent A blood agent is a toxic chemical agent that affects the body by being absorbed into the blood. Blood agents are fast-acting, potentially lethal poisons that typically manifest at room temperature as volatile colorless gases with a faint odor. Th ...
s (such as
hydrogen cyanide Hydrogen cyanide, sometimes called prussic acid, is a chemical compound with the formula HCN and structure . It is a colorless, extremely poisonous, and flammable liquid that boils slightly above room temperature, at . HCN is produced on an ...
) *
Drowning Drowning is a type of suffocation induced by the submersion of the mouth and nose in a liquid. Most instances of fatal drowning occur alone or in situations where others present are either unaware of the victim's situation or unable to offer a ...
*
Drug overdose A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.
* Exposure to extreme low pressure or
vacuum A vacuum is a space devoid of matter. The word is derived from the Latin adjective ''vacuus'' for "vacant" or "void". An approximation to such vacuum is a region with a gaseous pressure much less than atmospheric pressure. Physicists often dis ...
from
spacesuit A space suit or spacesuit is a garment worn to keep a human alive in the harsh environment of outer space, vacuum and temperature extremes. Space suits are often worn inside spacecraft as a safety precaution in case of loss of cabin pressure, ...
damage (see
space exposure Venturing into the environment of space can have negative effects on the human body. Significant adverse effects of long-term weightlessness include muscle atrophy and deterioration of the skeleton (spaceflight osteopenia). Other significant ef ...
) *
Hanging Hanging is the suspension of a person by a noose or ligature around the neck.Oxford English Dictionary, 2nd ed. Hanging as method of execution is unknown, as method of suicide from 1325. The ''Oxford English Dictionary'' states that hanging i ...
, whether suspension or short drop hanging * Self-induced
hypocapnia Hypocapnia (from the Greek words υπό meaning ''below normal'' and καπνός ''kapnós'' meaning ''smoke''), also known as hypocarbia, sometimes incorrectly called acapnia, is a state of reduced carbon dioxide in the blood. Hypocapnia usually ...
by
hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blood. ...
, as in shallow water or deep water blackout and the
choking game The choking game or blackout challenge is the act of intentionally cutting off oxygen to the brain with the goal of inducing temporary loss of consciousness and euphoria. Reasons for practice Limited research has been conducted regarding motivat ...
*
Inert gas asphyxiation Inert gas asphyxiation is a form of asphyxiation which results from breathing a physiologically inert gas in the absence of oxygen, or a low amount of oxygen, rather than atmospheric air (which is composed largely of nitrogen and oxygen). Examples ...
*
Congenital central hypoventilation syndrome Central hypoventilation syndrome (CHS) is a sleep-related breathing disorder that causes ineffective breathing, apnea, or respiratory arrest during sleep (and during wakefulness in severe cases). CHS can either be congenital (CCHS) or acquired ( ...
, or primary alveolar hypoventilation, a disorder of the autonomic nervous system in which a patient must consciously breathe; although it is often said that persons with this disease will die if they fall asleep, this is not usually the case *
Respiratory disease Respiratory diseases, or lung diseases, are pathology, pathological conditions affecting the organs and tissues that make gas exchange difficult in Breathing, air-breathing animals. They include conditions of the respiratory tract including the t ...
s *
Sleep apnea Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
* A
seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...
which stops breathing activity *
Strangling Strangling is compression of the neck that may lead to unconsciousness or death by causing an increasingly hypoxic state in the brain. Fatal strangling typically occurs in cases of violence, accidents, and is one of two main ways that hanging ...
* Breaking the
wind pipe The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from the ...
* Prolonged exposure to
chlorine gas Chlorine is a chemical element with the symbol Cl and atomic number 17. The second-lightest of the halogens, it appears between fluorine and bromine in the periodic table and its properties are mostly intermediate between them. Chlorine is ...


Smothering

Smothering is a mechanical obstruction of the flow of air from the environment into the mouth and/or nostrils, for instance, by covering the mouth and nose with a hand, pillow, or a plastic bag. Smothering can be either partial or complete, where partial indicates that the person being smothered is able to inhale some air, although less than required. In a normal situation, smothering requires at least partial obstruction of both the nasal cavities and the mouth to lead to asphyxia. Smothering with the hands or chest is used in some
combat sport A combat sport, or fighting sport, is a competitive contact sport that usually involves one-on-one combat. In many combat sports, a contestant wins by scoring more points than the opponent, submitting the opponent with a hold, disabling the oppon ...
s to distract the opponent, and create openings for transitions, as the opponent is forced to react to the smothering. In some cases, when performing certain routines, smothering is combined with simultaneous compressive asphyxia. One example is overlay, in which an adult accidentally rolls over onto an infant during
co-sleeping Co-sleeping is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of othe ...
, an accident that often goes unnoticed and is mistakenly thought to be
sudden infant death syndrome Sudden infant death syndrome (SIDS) is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usuall ...
. Other accidents involving a similar mechanism are
cave-in A cave-in is a collapse of a geologic formation, mine or structure which may occur during mining, tunneling, or steep-walled excavation such as trenching. Geologic structures prone to spontaneous cave-ins include alvar, tsingy and other limes ...
s or when an individual is buried in sand or grain. In
homicidal ''Homicidal'' is a 1961 American horror-thriller film produced and directed by William Castle William Castle (born William Schloss Jr.; April 24, 1914 – May 31, 1977) was an American film director, producer, screenwriter, and actor. Orph ...
cases, the term burking is often ascribed to a killing method that involves simultaneous smothering and compression of the torso. The term "burking" comes from the method William Burke and William Hare used to kill their victims during the
West Port murders The Burke and Hare murders were a series of sixteen killings committed over a period of about ten months in 1828 in Edinburgh, Scotland. They were undertaken by William Burke and William Hare, who sold the corpses to Robert Knox for dissection ...
. They killed the usually intoxicated victims by sitting on their chests and suffocating them by putting a hand over their nose and mouth, while using the other hand to push the victim's jaw up. The corpses had no visible injuries, and were supplied to medical schools for money.


Compressive asphyxia

Compressive asphyxia (also called chest compression) is mechanically limiting expansion of the lungs by compressing the torso, preventing breathing. "
Traumatic asphyxia Traumatic asphyxia, or Perthes's syndrome, is a medical emergency caused by an intense compression of the thoracic cavity, causing venous back-flow from the right side of the heart into the veins of the neck and the brain. Signs and symptoms Tr ...
" or "crush asphyxia" usually refers to compressive asphyxia resulting from being crushed or pinned under a large weight or force, or in a
crowd crush Crowd collapses and crushes are catastrophic incidents that can occur when a body of people becomes dangerously overcrowded. When a body of people reaches or exceeds the density of , the pressure on each individual can cause the crowd to collapse ...
. An example of traumatic asphyxia is a person who jacks up a car to work on it from below, and is crushed by the vehicle when the jack fails. Constrictor snakes such as
boa constrictor The boa constrictor (scientific name also ''Boa constrictor''), also called the red-tailed boa, is a species of large, non-venomous, heavy-bodied snake that is frequently kept and bred in captivity. The boa constrictor is a member of the family B ...
s kill through slow compressive asphyxia, tightening their coils every time the prey breathes out rather than squeezing forcefully. In cases of an adult co-sleeping with an infant ("overlay"), the heavy sleeping adult may move on top of the infant, causing compression asphyxia. In fatal crowd disasters, compressive asphyxia from being crushed against the crowd causes all or nearly all deaths, rather than
blunt trauma Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical traumas, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue ...
from trampling. This is what occurred at the Ibrox disaster in 1971, where 66 Rangers fans died; the 1979 The Who concert disaster where 11 died; the
Luzhniki disaster The Luzhniki disaster was a deadly human crush that took place at the Grand Sports Arena of the Central Lenin Stadium (russian: Большая спортивная арена Центрального стадиона им. В. И. Ленина ...
in 1982, when 66
FC Spartak Moscow FC Spartak Moscow (russian: Футбольный клуб «Спартак» Москва, Futbolʹnyy klub «Spartak» Moskva, ) is a Russian professional football club based in Moscow. Having won 12 Soviet championships (second only to Dyna ...
fans died; the
Hillsborough disaster The Hillsborough disaster was a fatal human crush during a football match at Hillsborough Stadium in Sheffield, South Yorkshire, England, on 15 April 1989. It occurred during an FA Cup semi-final between Liverpool and Nottingham Forest in the ...
in 1989, where 96
Liverpool Liverpool is a city and metropolitan borough in Merseyside, England. With a population of in 2019, it is the 10th largest English district by population and its metropolitan area is the fifth largest in the United Kingdom, with a popul ...
fans were crushed to death in an overcrowded terrace, 95 of the 96 from compressive asphyxia, 93 dying directly from it and 2 others from related complications; and the
Astroworld Festival crowd crush On November 5, 2021, a fatal Crowd collapses and crushes, crowd crush occurred during the first night of the 2021 Astroworld Festival, a music event founded by American musician Travis Scott that was held at NRG Park in Houston, Texas. Eight p ...
in 2021, where 10 died. More recently on the 29th of October 2022, 156 people were killed and over 152 were injured in Itaewon, South Korea on an evening of Halloween celebrations. In confined spaces, people are forced to push against each other; evidence from bent steel railings in several fatal crowd accidents has shown horizontal forces over 4500 N (equivalent to a weight of approximately 450 kg or 1000 lbs). In cases where people have stacked up on each other in a human pile, it has been estimated that those at the bottom are subjected to around 380 kg (840 lbs) of compressive weight. "Positional" or "restraint" asphyxia is when a person is restrained and left alone prone, such as in a police vehicle, and is unable to reposition themself in order to breathe. The death can be in the vehicle, or following loss of consciousness to be followed by death while in a coma, having presented with anoxic brain damage. The asphyxia can be caused by facial compression, neck compression, or chest compression. This occurs mostly during restraint and handcuffing situations by law enforcement, including psychiatric incidents. The weight of the restraint(s) doing the compression may contribute to what is attributed to positional asphyxia. Therefore, passive deaths following custody restraint that are presumed to be the result of positional asphyxia may actually be examples of asphyxia occurring during the restraint process. Chest compression is a technique used in various
grappling Grappling, in hand-to-hand combat, describes sports that consist of gripping or seizing the opponent. Grappling is used at close range to gain a physical advantage over an opponent, either by imposing a position or causing injury. Grappling i ...
combat sports, where it is sometimes called wringing, either to tire the opponent or as complementary or distractive moves in combination with pinning holds, or sometimes even as
submission holds A grappling hold, commonly referred to simply as a hold that in Japanese is referred to as ''katame-waza'' ( "grappling technique"), is any specific grappling, wrestling, judo, or other martial art grip that is applied to an opponent. Grapplin ...
. Examples of chest compression include the
knee-on-stomach position Knee-on-stomach, or knee-on-belly, knee-on-chest, knee-ride, knee mount (''uki-gatame'', 浮固, "floating hold"Kawaishi, Mikonosuke (1955). ''My method of judo''. W. Foulsham & Co. in budō), is a grappling position#Ground grappling position, d ...
; or techniques such as leg scissors (also referred to as body scissors and in
budō is a Japanese term describing modern Japanese martial arts. Literally translated it means the "Martial Way", and may be thought of as the "Way of War" or the "Way of Martial Arts". Etymology Budō is a compound of the root ''bu'' ( 武:ぶ), m ...
referred to as ''do-jime''; 胴絞, "trunk strangle" or "body triangle") where a participant wraps his or her legs around the opponent's midsection and squeezes them together. Pressing is a form of
torture Torture is the deliberate infliction of severe pain or suffering on a person for reasons such as punishment, extracting a confession, interrogation for information, or intimidating third parties. Some definitions are restricted to acts c ...
or
execution Capital punishment, also known as the death penalty, is the State (polity), state-sanctioned practice of deliberately killing a person as a punishment for an actual or supposed crime, usually following an authorized, rule-governed process to ...
using compressive asphyxia.


Perinatal asphyxia

Perinatal asphyxia is the medical condition resulting from deprivation of
oxygen Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as wel ...
(
hypoxia Hypoxia means a lower than normal level of oxygen, and may refer to: Reduced or insufficient oxygen * Hypoxia (environmental), abnormally low oxygen content of the specific environment * Hypoxia (medical), abnormally low level of oxygen in the tis ...
) to a newborn infant long enough to cause apparent harm. It results most commonly from a drop in maternal
blood pressure Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" r ...
or interference during delivery with blood flow to the infant's
brain A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
. This can occur as a result of inadequate circulation or
perfusion Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion is measured as the rate at which blood is deliver ...
, impaired respiratory effort, or inadequate
ventilation Ventilation may refer to: * Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation ** Mechanical ventilation, in medicine, using artificial methods to assist breathing *** Ventilator, a m ...
. There has long been a scientific debate over whether newborn infants with asphyxia should be resuscitated with 100% oxygen or normal air. It has been demonstrated that high concentrations of oxygen lead to generation of oxygen
free radicals In chemistry, a radical, also known as a free radical, is an atom, molecule, or ion that has at least one unpaired valence electron. With some exceptions, these unpaired electrons make radicals highly chemically reactive. Many radicals spont ...
, which have a role in
reperfusion injury Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood supply returns to tissue ('' re-'' + '' perfusion'') after a period of ischemia or lack of oxygen (anoxia or h ...
after asphyxia. Research by
Ola Didrik Saugstad Ola Didrik Saugstad (born 5 March 1947) is a Norwegian pediatrician, neonatologist and neuroscientist noted for his research on resuscitation of newborn children and his contribution to reduce child mortality. He is a Research Professor at Oslo ...
and others led to new international guidelines on newborn resuscitation in 2010, recommending the use of normal air instead of 100% oxygen.


Mechanical asphyxia

Classifications of different forms of asphyxia vary among literature, with differences in defining the concept of mechanical asphyxia being the most obvious. In DiMaio and DiMaio's 2001 textbook on forensic pathology, mechanical asphyxia is caused by pressure from outside the body restricting respiration. Similar narrow definitions of mechanical asphyxia have occurred in Azmak's 2006 literature review of asphyxial deaths and Oehmichen and Auer's 2005 book on forensic neuropathology. According to DiMaio and DiMaio, mechanical asphyxia encompasses positional asphyxia, traumatic asphyxia, and "human pile" deaths. In Shkrum and Ramsay's 2007 textbook on forensic pathology, mechanical asphyxia occurs when any mechanical means cause interference with the exchange of oxygen and carbon dioxide in the body. Similar broad definitions of mechanical asphyxia have occurred in Saukko and Knight's 2004 book on asphyxia, and Dolinak and Matshes' 2005 book on forensic pathology. According to Shkrum and Ramsay, mechanical asphyxia encompasses smothering, choking, positional asphyxia, traumatic asphyxia, wedging, strangulation and drowning. Sauvageau and Boghossian propose in 2010 that mechanical asphyxia should be officially defined as caused by "restriction of respiratory movements, either by the position of the body or by external chest compression", thus encompassing only positional asphyxia and traumatic asphyxia. First aid If there are symptoms of mechanical asphyxia, it is necessary to call an
Emergency Medical Services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
. In some countries, such as the US, there may also be self-acting groups of voluntary first responders who have been trained in first aid. In case of mechanical asphyxia, first aid can be provided on your own. In such a situation, you need to do the following: * Stand behind the affected person and wrap your arms around him/her. * Push inwards and upwards under the ribs with a sudden movement by your second hand. * If the performed actions were not effective, repeat them until you free respiratory tract of the affected person from a foreign body.


See also

* * * *


References


Further reading

* *


External links

*
Cross-side to chest compression choke
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