16-year-old Levi Draher of San Antonio in Texas in the US almost died of a choking game. He has survived to campaign against such dangerous games.
Levi was found suspended on a rope he had slung across a bunk-bed frame. He had pushed his neck onto the rope. He wanted to achieve a surging rush as his brain was starved of blood but replenished just before the point of unconsciousness.
The rush is the appeal of the choking game or space cowboy or cloud nine or any of a dozen other names.
But what happened to Levi was he passed out faster than he could react. His brain was deprived of oxygen for more than three minutes. He was clinically dead.
He spent three days in a coma followed by a regimen of anti-seizure drugs.
Increasingly teenagers are seeing such choking games on Internet sites like YouTube, and playing them in more threatening variations. More often, like Levi, alone, and with a rope. And many deaths have resulted.
There is now a group called the Dylan Blake Foundation, founded by a parent who lost an 11-year-old son in 2005. It has mounted a sustained campaign against such misadventures.
It says there were at least 40 deaths and 5 serious injuries resulting from choking games in the United States alone last year.
In 2004, according to the most recent figures from the federal Centers for Disease Control and Prevention, 779 children between ages 10 and 19 committed suicide by suffocation. The figure ranged in the region of 400 to 450 per year between the early 1980s through the mid-1990s.
Now experts wonder whether it was all suicide or a suffocation game gone wrong.
Greater awareness in the medical community is in turn leading to the first serious scientific research about the game's prevalence.
"Asphyxiation games have been with us for generations, but what makes the current generation's execution of this game different is that more kids are willing to play it alone," said Dr. Thomas Andrew, the chief medical examiner in New Hampshire.
Anxiety about sex is another entanglement in the discussion. In some older teenagers and adults, the game can become associated with autoerotic practices of masturbation or intercourse to intensify orgasms, it is felt.
However, some experts feel sex is not a factor for younger teenagers. There was also no sex or ejaculation in Levi's case, his mother said.
Andrews suggested elders should talk children out of such life-threatening games.
Warning of death could be fine. But mentioning specific risks like brain damage or physical disfigurement could have greater impact, he noted.