Human cardiovascular effects of a new generation conducted electrical weapon

Ho, Jeffrey D.; Dawes, Donald M.; Reardon, Robert F.; Strote, Seth R.; Kunz, Sebastian; Nelson, Rebecca S.; Lundin, Erik J.; Orozco, Benjamin S.; Miner, James R.

doi:10.1016/j.forsciint.2010.05.003

Cited by 52 publications

(38 citation statements)

References 34 publications

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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: 95%

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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Section: Discussionmentioning

confidence: 95%

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

et al. 2014

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“…21 Although nonphysiological porcine studies have suggested that dart-toheart distances of 4 to 17 mm are required to produce VF, 24,25 TASER ECD shocks with 1 dart in the right chest and the second in the abdomen or right groin, distances exceeding 4 to 17 mm, have been shown to capture the heart in intact pigs 17 and humans. 26 Rahko, 27 evaluating skin-to-heart distance by echocardiography, stated, "An EMD dart penetrating the skin directly over the heart might put individuals at risk for ventricular fibrillation" and noted that the skin-to-heart distance correlated with BMI. Using the porcine finding 24 of 26-mm skin-to-heart distance as a threshold value for individuals ECGs from a pig taken before (A) and after (B and C) TASER X26 discharge.…”

Section: Dart-to-heart Distancementioning

confidence: 99%

“…The ventricular electrograms during X26 cardiac capture were different from those during pacemaker capture, consistent with cardiac capture from the TASER shocks directly from the X26 and not over the pacemaker lead (l. Saxon, MD, personal communication, 2013 ). The second study 26 tested a new-generation TASER ECD on normal supine human volunteers using echocardiographic monitoring. It demonstrated "an apparent brief episode of cardiac capture" at a rate of 240 bpm during the 10-second TASER ECD shock.…”

Section: Clinical Researchmentioning

confidence: 99%

TASER Electronic Control Devices Can Cause Cardiac Arrest in Humans

Zipes

2014

Circulation

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“…3 Importantly, this is the only published human study in which discharge was administered through a chest-penetrating barb located over the heart. The study demonstrated in a single subject a 240-bpm ventricular capture that persisted for the duration of the ECD discharge.…”

Section: To the Editormentioning

confidence: 99%

Letter by Sheridan Regarding Articles, “TASER Electronic Control Devices Can Cause Cardiac Arrest in Humans” and “TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?”

Sheridan

2014

Circulation

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Human cardiovascular effects of a new generation conducted electrical weapon

Cited by 52 publications

References 34 publications

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

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

TASER Electronic Control Devices Can Cause Cardiac Arrest in Humans

Letter by Sheridan Regarding Articles, “TASER Electronic Control Devices Can Cause Cardiac Arrest in Humans” and “TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?”

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