The Centers for Disease Control says it's also known as the pass-out game or suffocation roulette, and they warn within three minutes of continued strangulation basic functions such as memory, balance and the central nervous system can start to fail.
Denuo Miley, 13, says for him trying it once was enough.
"I didn't know what to think, I just dropped," Miley said. "It took me from behind, I didn't expect nothing to go on, then I just got tired, and dropped, and when I dropped I was shaking and they helped me up afterwards."
Miley is one of the nine West Hoke Middle School students on suspension for choking each other.
West Hoke Middle School Principal Mary McLeod says she and other administrators became suspicious after two boys were hurt after passing out. She says what they found out shocked them.
"The boys were choking one another in the bathrooms, boys locker rooms," McLeod said. "Some parents did know this was taking place. I was very disappointed the parents didn't know, call the school and share information with the school and let us know."
Miley says some of his classmates learned about the choking game from the internet.
Death can occur quickly and in 2007 a 10-year-old Harnett County boy hanged himself in his parent's closet while playing the game by himself.
Hoke County school officials say not all of the nine middle school parents knew the dangers, but some of the students did.
"I did personally interview some kids and they understood the danger of it, but still the kids were challenged by peer pressure to participate," Hoke School Superintendant Dr. Fred Williamson said.
The news terrifies Loretta Cooper-Jones, Miley's aunt and guardian. She hopes to raise parents awareness and put them guard.
"Like bloodshot eyes, maybe wearing collars up to where they are hiding their neck marks or kids constantly complaining about headaches," she said.
Miley says he's learned his lesson, and hopes his classmates have too.
"When I found out you could die from it, I wouldn't let anybody touch me again," he said.