Point-of-Care Testing in Out-of-Hospital Cardiac Arrest: A Retrospective Analysis of Relevance and Consequences

Grübl, Tobias; Ploeger, Birgit; Wranze-Bielefeld, Erich; Mueller, Markus M.; Schmidbauer, Willi; Kill, Clemens; Betz, Susanne

doi:10.21203/rs.3.rs-489129/v1

Cited by 2 publications

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References 14 publications

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“…Blood may also be drawn in the field or in the emergency department for either point-of-care (POC) testing or later laboratory analysis [123,124]. Samples should be collected in air-tight containers or tested as soon as possible due to gaseous diffusion.…”

Section: Other Informationmentioning

confidence: 99%

Prone restraint cardiac arrest in in‐custody and arrest‐related deaths

Weedn

Steinberg²,

Speth³

2022

Journal of Forensic Sciences

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We postulate that most atraumatic deaths during police restraint of subjects in the prone position are due to prone restraint cardiac arrest (PRCA), rather than from restraint asphyxia or a stress-induced cardiac condition, such as excited delirium. The prone position restricts ventilation and diminishes pulmonary perfusion. In the setting of a police encounter, metabolic demand will be high from anxiety, stress, excitement, physical struggle, and/or stimulant drugs, leading to metabolic acidosis and requiring significant hyperventilation.Although oxygen levels may be maintained, prolonged restraint in the prone position may result in an inability to adequately blow off CO 2 , causing blood pCO 2 levels to rise rapidly.The uncompensated metabolic acidosis (low pH) will eventually result in loss of myocyte contractility. The initial electrocardiogram rhythm will generally be either pulseless electrical activity (PEA) or asystole, indicating a noncardiac etiology, more consistent with PRCA and inconsistent with a primary role of any underlying cardiac pathology or stress-induced cardiac etiology. We point to two animal models: in one model rats unable to breathe deeply due to an external restraint die when their metabolic demand is increased, and in the other model, pressure on the chest of rats results in decreased venous return and cardiac arrest rather than death from asphyxia. We present two cases of subjects restrained in the prone position who went into cardiac arrest and had low pHs and initial PEA cardiac rhythms. Our cases demonstrate the danger of prone restraint and serve as examples of PRCA. K E Y W O R D Sprone restraint, in-custody deaths, arrest-related deaths (ARDs), police-involved deaths, restraint asphyxia, positional asphyxia, excited delirium, sudden cardiac death, metabolic acidosis, George Floyd, forensic pathology, autopsy Highlights• Prone restraint deaths result from metabolic acidosis, not hypoxic asphyxia.• Metabolic demand is increased by stimulant drugs, physical exertion, and stress.• Metabolic acidosis requires hyperventilation to "blow off" carbon dioxide (CO 2 ).• Prolonged restraint in the prone position may prevent adequate elimination of CO 2 .• An initial ECG rhythm of PEA or asystole after a cardiac arrest is generally inconsistent with a primary cardiac etiology.How to cite this article: Weedn V, Steinberg A, Speth P. Prone restraint cardiac arrest in in-custody and arrest-related deaths.

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Section: Other Informationmentioning

confidence: 99%

Prone restraint cardiac arrest in in‐custody and arrest‐related deaths

Weedn

Steinberg²,

Speth³

2022

Journal of Forensic Sciences

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“…Symptome beginnen ab 15-20 % MetHb und Fälle mit mehr als 60-80 % verlaufen ohne umgehende Behandlung tödlich [3,4]. Anhand transportabler BGA-Geräte kann heute durch entsprechende Messkomponenten neben dem Säure-Basen-Status auch die MetHb-Konzentration bereits an der Einsatzstelle bestimmt werden [5].…”

Section: Therapie Und Verlaufunclassified

Prähospitaler Kreislaufstillstand unter einem seltenen Umstand

Grübl

Günnewig²,

Schulte

et al. 2022

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ZusammenfassungEs wird der Fall eines jungen Patienten mit Kreislaufstillstand nach suizidaler Inkorporation von Natriumnitrat beschrieben.Während der Reanimation sind reversible Ursachen zu suchen und schnell zu therapieren. Intoxikationen sind dabei oft nur schwer detektierbar. Nitroverbindungen führen zur Bildung von Methämoglobin und so zur Hypoxie. Anhand mobiler Laborgeräte kann dies bereits prähospital diagnostiziert werden. Therapeutisch ist zunächst ein symptomatisches Vorgehen mit Oxygenierung und Kreislaufunterstützung sowie ggf. erweiterten Maßnahmen angezeigt. Auch für seltene Intoxikationen sollten spezifische Antidota zumindest zentral vorgehalten werden. Notfallmediziner müssen die Zugriffs- und alternative Behandlungsmöglichkeiten bis zu deren Verfügbarkeit kennen. Im Falle eines Kreislaufstillstands können Systeme zur extrakorporalen Kreislaufunterstützung diesen Zeitraum überbrücken.

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Point-of-Care Testing in Out-of-Hospital Cardiac Arrest: A Retrospective Analysis of Relevance and Consequences

Cited by 2 publications

References 14 publications

Prone restraint cardiac arrest in in‐custody and arrest‐related deaths

Prone restraint cardiac arrest in in‐custody and arrest‐related deaths

Prähospitaler Kreislaufstillstand unter einem seltenen Umstand

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