Echocardiographic Evaluation of a TASER‐X26 Application in the Ideal Human Cardiac Axis

Ho, Jeffrey D.; Dawes, Donald M.; Reardon, Robert F.; Lapine, Anne; Dolan, Benjamin J.; Lundin, Erik J.; Miner, James R.

doi:10.1111/j.1553-2712.2008.00201.x

Cited by 50 publications

(25 citation statements)

References 20 publications

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“…[8][9][10][11][12][13] Under some experimental conditions, CEWs can induce VF in animals using probe discharges across the anterior chest; 8,13,14 but they have not been reported to induce VF or any other arrhythmias in human volunteers. 26,27 There is uncertainty regarding how results of these studies relate to sudden death after tactical exposure to CEWs: VF thresholds for external electrical stimulation may differ between smaller, anesthetized animals and larger, awake humans. The controlled conditions of research in humans do not duplicate the stresses of tactical interactions, and volunteers, usually law enforcement officers, differ from decedents, who often use street drugs and are typically in less robust physical condition.…”

Section: Cardiac Effects Of Cewsmentioning

confidence: 99%

Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons

Swerdlow

Fishbein²,

Chaman³

et al. 2009

Academic Emergency Medicine

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Objectives: Sudden deaths proximate to use of conducted electrical weapons (CEWs) have been attributed to cardiac electrical stimulation. The rhythm in death caused by rapid, cardiac electrical stimulation usually is ventricular fibrillation (VF); electrical stimulation has not been reported to cause asystole or pulseless electrical activity (PEA). The authors studied the presenting rhythms in sudden deaths temporally proximate to use of TASER CEWs to estimate the likelihood that these deaths could be caused by cardiac electrical stimulation.Methods: This was a retrospective review of CEW-associated, nontraumatic sudden deaths from 2001 to 2008. Emergency medical services (EMS), autopsy, and law enforcement reports were requested and analyzed. Subjects were included if they collapsed within 15 minutes of CEW discharge and the first cardiac arrest rhythm was reported.Results: Records for 200 cases were received. The presenting rhythm was reported for 56 of 118 subjects who collapsed within 15 minutes (47%). The rhythm was VF in four subjects (7%; 95% confidence interval [CI] = 3% to 17%) and bradycardia-asystole or PEA in 52 subjects (93%; 95% CI = 83% to 97%). None of the eight subjects who collapsed during electrocardiogram (ECG) monitoring had VF. Only one subject (2%) collapsed immediately after CEW discharge. This was the only death typical of electrically induced VF (2%, 95% CI = 0% to 9%). An additional 4 subjects (7%) collapsed within 1 minute, and the remaining 51 subjects (91%) collapsed more than 1 minute later. The time from collapse to first recorded rhythm was 3 minutes or less in 35 subjects (62%) and 5 minutes or less in 43 subjects (77%). Conclusions:In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and VF is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.ACADEMIC EMERGENCY MEDICINE 2009; 16:726-739 ª

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Section: Cardiac Effects Of Cewsmentioning

confidence: 99%

Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons

Swerdlow

Fishbein²,

Chaman³

et al. 2009

Academic Emergency Medicine

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“…25,26 These BMIs match the BMIs of arrest-related death subjects. In Stratton et al The discrepancy between the animal findings and human findings may be weight-related (although we did have capture in some large control animals), species-related (differences in susceptibility, chest shape and charge distribution, cardiac anatomy), related to experimental conditions (anesthetized and mechanically ventilated sheep vs. awake humans), or related to very specific positioning of the probes.…”

Section: Discussionmentioning

confidence: 76%

Effect of an Electronic Control Device Exposure on a Methamphetamine‐intoxicated Animal Model

Dawes

Cole

et al. 2010

Academic Emergency Medicine

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Objectives: Because of the prevalence of methamphetamine abuse worldwide, it is not uncommon for subjects in law enforcement encounters to be methamphetamine-intoxicated. Methamphetamine has been present in arrest-related death cases in which an electronic control device (ECD) was used. The primary purpose of this study was to determine the cardiac effects of an ECD in a methamphetamine intoxication model. Methods:Sixteen anesthetized Dorset sheep (26-78 kg) received 0.0 mg ⁄ kg (control animals, n = 4), 0.5 mg ⁄ kg (n = 4), 1.0 mg ⁄ kg (n = 4), or 1.5 mg ⁄ kg (n = 4) of methamphetamine hydrochloride as a slow intravenous (IV) bolus during continuous cardiac monitoring. The animals received the following exposures in sequence from a TASER X26 ECD beginning at 30 minutes after the administration of the drug: 1) 5-second continuous exposure, 2) 15-second intermittent exposure, 3) 30-second intermittent exposure, and 4) 40-second intermittent exposure. Darts were inserted at the sternal notch and the cardiac apex, to a depth of 9 mm. Cardiac motion was determined by thoracotomy (smaller animals, £ 32 kg) or echocardiography (larger animals, > 68 kg). Data were analyzed using descriptive statistics and chi-square tests.Results: Animals given methamphetamine demonstrated signs of methamphetamine toxicity with tachycardia, hypertension, and atrial and ventricular ectopy in the 30-minute period immediately after administration of the drug. Smaller animals (n = 8, £ 32 kg, mean = 29.4 kg) had supraventricular dysrhythmias immediately after the ECD exposures. Larger animals (n = 8, > 68 kg, mean = 72.4) had only sinus tachycardia after the exposures. One of the smaller animals had frequent episodes of ventricular ectopy after two exposures, including runs of delayed onset, nonsustained six-to eight-beat unifocal and multifocal ventricular tachycardia that spontaneously resolved. This animal had significant ectopy prior to the exposures as well. Thoracotomy performed on three smaller animals demonstrated cardiac capture during ECD exposure consistent with previous animal studies. In the larger animals, none of the methamphetamine-intoxicated animals demonstrated cardiac capture. Two control sheep showed evidence of capture similar to the smaller animals. No ventricular fibrillation occurred after the exposure in any animal. Conclusions:In smaller animals (32 kg or less), ECD exposure exacerbated atrial and ventricular irritability induced by methamphetamine intoxication, but this effect was not seen in larger, adult-sized animals. There were no episodes of ventricular fibrillation after exposure associated with ECD exposure in methamphetamine-intoxicated sheep.ACADEMIC EMERGENCY MEDICINE 2010; 17:436-443 ª

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“…21,22 Human echocardiographic studies have not found cardiac capture with precordial electrodes with any commercially available ECD. [48][49][50] These data suggest that the threshold of factual evidence for blaming a cardiac arrest on an ECD should be set very high. The published case reports have not met that threshold.…”

Section: Discussionmentioning

confidence: 99%

TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?

et al. 2014

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Being arrested is a highly emotional event and can result in a fatal, adrenergically supercharged physiological state. 1 The exertion of arrest-related struggle is several-fold greater than that seen with normal exercise and leads to numerous extreme metabolic and electrolytic derangements, including elevated levels of lactate, CO 2 , potassium, creatine kinase, and myoglobin.2 Only 1.6% of US law-enforcement interactions involve the use or threats of force, and annually there are ≈700 000 cases in which force is used or threatened.3 There are ≈700 arrest-related deaths per year in the United States, yielding a mortality rate of ≈1 in 1000 for a law-enforcement interaction associated with force. 4 Response by Zipes on p 100The electronic control device (ECD) has gained widespread acceptance as the force option for law enforcement because of its dramatic reduction in both suspect and officer injury. At the same time, advocacy groups post statements on the Internet listing the hundreds of arrest-related deaths after ECD use with the implication that the ECD involvement was causal. Studies covering a total of >48 000 forceful arrests have consistently found suspect injury rate reductions of ≈65%.5,6 Of the 250 000 annual ECD field uses in the United States, only 1 in 4000 is involved in an arrest-related death. This reduction in fatality rate is consistent with published data showing that 5.4% of ECD uses "clearly prevented the use of lethal force by police." 7Of the >3 million total ECD applications, there have been 12 published case reports suggesting a potential cardiac arrest link, giving an incidence of 4×10 −6 per application. [8][9][10][11][12][13] In most cases, those authors did not consider important factors that are now better understood. These include separating postural from cardiovascular collapse, the latency of electrically induced ventricular fibrillation (VF), the presence of significant cardiac pathology, failure of prompt defibrillation, the duration of documented breathing, the distance of the ECD electrode from the heart, and the stability of electrically induced VF. We have thoroughly investigated these cases as either TASER scientific advisors or expert witnesses. The goal of this article is to resolve the confusion about these cases by introducing more complete data and by using a consistent case-report scoring methodology. Methods Understanding the Confounders Postural Versus Cardiovascular CollapseIn the normal course of life, an exertional postural collapse is, correctly, often associated with a cardiac arrest. However, it is sometimes forgotten that the ECD design goal is to cause a postural collapse to stop aggression. A sternal rub response is often blunted by the presence of alcohol, illegal drugs, psychotic break, and endorphins from the struggle. Hence, nonresponsiveness is also more difficult to evaluate in the law-enforcement scenario.(Circulation. 2014;129:93-100)

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Echocardiographic Evaluation of a TASER‐X26 Application in the Ideal Human Cardiac Axis

Cited by 50 publications

References 20 publications

Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons

Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons

Effect of an Electronic Control Device Exposure on a Methamphetamine‐intoxicated Animal Model

TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?

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