This is considered a "HIGH RISK" activity however so be careful and play SAFE!
I think this about covers it as a "caveat". The people that die are the fools like David Caradine and the INXS guy that hang themselves with a belt or rope, then pass out from blood loss, can't save themselves and suffocate.
And yes, this is HEAVY on the Dominance side of "Alternative" sex. It is very thrilling to truly be at the mercy of someone you trust and just as thrilling to have someone submit that completely to you and put themselves at your mercy. A lot of the sex that most people are NOT having takes place between your ears people, the sooner more people get that, the more happy and horny people we will have walking the streets.