Arrest-related death on the basis of a drug-induced excited delirium syndrome

Kunz, Sebastian; Þórðardóttir, S.; Jónasson, Jón Gunnlaugur

doi:10.1016/j.jflm.2020.102091

Cited by 7 publications

(1 citation statement)

References 29 publications

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“…72,73 Pre-existing venous return impairment caused by chest and abdominal compression might have had the same effects of gravity on venous return as those in a fainting lark syncope. 46,56 In the case report by Kunz et al (BMI: 27.2 kg/m 2 ), 74 the individual's pre-existing clinical condition (psychostimulants; severe physical exhaustion) before the restraint process was at odds with Robert Dziekanski's. On the basis of the study by Kroll et al, 13 the sudden increase in intrathoracic pressure caused by the double-knee restraint technique, rather than situational syncope, appears as the most likely factor precipitating the malignant arrhythmia clinically.…”

Section: Dynamic Weight Force Restraint Techniquementioning

confidence: 99%

Prone restraint death: Possible role of the Valsalva maneuver

Michaud¹

2023

Med Sci Law

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There is an on-going debate about the safety of prone restraint and the exact role of the prone position in physical restraint death. Cardiac arrest in prone restraint death is essentially the end-result of a violent physical altercation wherein a combative individual suddenly loses consciousness while trying to counteract an opposing force. The direct correlations of increased static weight force with decreased inferior vena cava diameter, decreased cardiac output, and decreased stroke volume in prone restraint studies suggest that decreased venous return and decreased cardiac output could have a significant role to play in prone restraint death. Although the degree of changes observed in those studies might not be sufficient to cause cardiac arrest, they could predispose people who instinctively try to free themselves of the restraints to severe complications. The Valsalva maneuver, or forceful expiration against a closed airway, is frequently performed spontaneously in daily activities involving straining and resistance exercise, but has never been considered in restraint death. Pre-existing diminished venous return could increase the risk of major complications in individuals performing the Valsalva maneuver. A substantial decrease in venous return and cardiac output could increase the risk of cerebral hypoperfusion, loss of consciousness, hypoventilation, and sudden death. By increasing the risk of increased intra-abdominal pressure and its negative effect on venous return, high body mass index may be a significant risk factor in prone restraint death. The Valsalva maneuver may have different roles in prone restraint cardiac arrest and might be overlooked in prone restraint death.

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