Choke-out

A choke-out is a hand-to-hand combat tactic involving the use of a chokehold to cause syncope, or temporary loss of consciousness, at which point the choke is released. Common chokeholds in grappling used to accomplish a choke-out include the rear naked choke, arm triangle, triangle choke, and the guillotine.

The mechanics behind choke-outs are disputed. It has been explained as resulting from directly constraining blood flow to the brain. A competing theory involves compression of the baroreceptors of the carotid artery, confusing the body into thinking blood pressure has risen. Due to the baroreflex, this causes vasodilation, or widening of the brain's blood vessels intended to relieve high pressure. Since no blood pressure increase has actually occurred, the dilation causes a dramatic decrease in blood pressure to the brain, or brain ischemia, which then causes loss of consciousness.

Choke-outs should not be confused with erotic asphyxiation or the fainting game, wherein a person loses consciousness intentionally in order to experience a particular sensation. A choke-out should also not be confused with medical conditions that cause fainting without the application of a chokehold.

Mechanics
The vulnerable carotid artery, (large, red tube), and the vagus nerve running parallel on its left

Chokeholds can be divided into two primary categories: "blood chokes" and "air chokes". A blood choke disrupts blood circulation to the brain, while an air choke disrupts breathing. Blood chokes can be applied to efficiently cause loss of consciousness, i.e. a choke-out, while air chokes do not usually cause loss of consciousness without prolonged application (though air chokes are used to cause discomfort).

Blood chokes constrain or disrupt blood circulation to the brain. This is accomplished by compressing one or both of the carotid arteries and/or the jugular veins, ideally with little to no pressure applied to the airway.

One theory on the mechanics of choke-outs claims that unconsciousness results from the direct constraint of blood flow to the brain, causing cerebral hypoxia.[1]

Another more complex theory states that as pressure is applied to the carotid artery, baroreceptors (the body's natural blood pressure monitors) within the artery are also compressed. When they sense too much pressure in an artery that feeds the brain (such as those in the neck), they signal the brain to dilate (widen) its blood vessels in order to relieve pressure (baroreflex causing vasodilation). Since blood pressure has not actually increased as the brain thinks it has, the dilation causes pressure to drop dramatically, and can be sufficient to cause cerebral hypoxia.

Dangers

There is debate over the dangers of choke-outs. After 4 to 6 minutes of sustained cerebral anoxia, permanent brain damage will begin to occur,[2] but the long-term effects of a controlled choke-out for less than 4 minutes (as most are applied for mere seconds and released when unconsciousness is achieved) are disputed.[3] There is always risk of short-term memory loss, hemorrhage and harm to the retina, concussions from falling when unconscious, stroke, seizures, permanent brain damage, coma, and even death.[4]

Some argue that when pressure is applied to the carotid artery, the baroreceptors send a signal to the brain via the glossopharyngeal nerve[5] and the heart via the vagus nerve. This signal tells the heart to reduce volume of blood per heartbeat, typically up to one-third, in order to further relieve high pressure. There is a slight chance of the rate dropping to zero, or flatline (asystole).[6] However, there are several studies that showed choking out will result in a few seconds of flat line ECG for a few seconds at least in half of the subjects.[7] This might suggest that choking out or syncope is not as safe as it was assumed to be previously.

Some argue that with thousands of tournaments since the sport of Judo began in 1882, hundreds of thousands of chokes have been applied, and the probability of hundreds if not thousands of choke-outs, with no reported deaths due to chokes, the chances of asystole are slim.[8] It might be true that no direct death has reported as a result of chokes but there are numerous reports of these chokes turned out to strokes leaving the subject with permanent brain damage or possible more elaborated long-term effects [9]

Effects

The American Neurological Association's study entitled “Syncope: A videometric analysis of 56 episodes of transient cerebral hypoxia” observed the effects of cerebral hypoxia on 42 test subjects who completely lost consciousness. Their syncope state lasted 12.1 seconds, plus or minus 4.4 seconds. Muscle jerks occurred in 90% of patients. The most common pattern of movement consisted of multifocal arrhythmic jerks (uncoordinated spasms of multiple muscle groups) in both proximal and distal muscles. Additional movements also occurred such as: righting movements (if the patient had slumped one way while falling asleep they woke up and immediately corrected, if not overcorrected), oral automatisms, and head turns. In most of the patients their eyes remained open. Sixty percent of the patients reported having visual and auditory hallucinations.[7]

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References
  1. Mitchell, Jamie R.; Roach, Dan E.; Tyberg, John V.; Belenkie, Israel; Sheldon, Robert S. (2012). "Mechanism of loss of consciousness during vascular neck restraint". Journal of Applied Physiology. 112 (3): 396–402. doi:10.1152/japplphysiol.00592.2011. PMID 22096121. Lay summary – SB Nation (April 6, 2012).
  2. MedlinePlus Encyclopedia: Cerebral hypoxia
  3. Cash, Ralph E. (November 2007). "A Dangerous High" (PDF). Principal Leadership. 8 (3): 10–3.
  4. Neumann-Potash, L. (Fall 2006). "The choking game". California Pediatrician: 22. ISSN 0882-3421.
  5. CONSTANTINOS H. DAVOS, LEWIS CERI DAVIES, MASSIMO PIEPOLI. The Effect of Baroreceptor Activity on Cardiovascular Regulation. Hellenic J Cardiol 43: 145-155, 2002. Retrieved from "Archived copy" (PDF). Archived from the original (PDF) on 2015-11-23. Retrieved 2015-11-23.CS1 maint: archived copy as title (link)
  6. Wiseman, Jay (1997). "The Medical Realities Of Breath Control Play".
  7. Lempert, T.; Bauer, M.; Schmidt, D. (1994). "Syncope: A videometric analysis of 56 episodes of transient cerebral hypoxia". Annals of Neurology. 36 (2): 233–7. doi:10.1002/ana.410360217. PMID 8053660.
  8. Koiwai, E. Karl (1987). "Deaths allegedly caused by the use of 'choke holds' (shime-waza)". Journal of Forensic Sciences. 32 (2): 419–32. PMID 3572335.
  9. Urkin, Jacob; Merrick, Joav (2006). "The choking game or suffocation roulette in adolescence". International Journal of Adolescent Medicine and Health. 18 (2): 207–8. doi:10.1515/IJAMH.2006.18.2.207. PMID 16894858.
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