Sudden Cardiac Arrest and Death Following Application of Shocks From a TASER Electronic Control Device

Abstract

Background-The safety of electronic control devices (ECDs) has been questioned. The goal of this study was to analyze in detail cases of loss of consciousness associated with ECD deployment. Methods and Results-Eight cases of TASER X26 ECD-induced loss of consciousness were studied. In each instance, when available, police, medical, and emergency response records, ECD dataport interrogation, automated external defibrillator information, ECG strips, depositions, and autopsy results were analyzed. First recorded rhythms were ventricular tachycardia/fibrillation in 6 cases and asystole (after Ϸ30 minutes of nonresponsiveness) in 1 case. An external defibrillator reported a shockable rhythm in 1 case, but no recording was made. This report offers evidence detailing the mechanism by which an ECD can produce transthoracic stimulation resulting in cardiac electrical capture and ventricular arrhythmias leading to cardiac arrest. Conclusions-ECD

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

“…7 Of 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.…”

“…Because most illnesses have latency periods measured in days, not seconds, it is common for even physicians to significantly overestimate the latency period for electrocution. 8,13 However, these latency periods are well established and are summarized in the online-only Data Supplement. Some of the cited case studies confuse loss of consciousness minutes later as "precisely" temporal to an alleged electrocution.…”

Electronic Control Devices

“…Although a significant number of deaths in association with, or following the use of, ECDs have been cited in a lay publication, 1 peer-reviewed literature on the topic has been limited to several case reports, largely in the form of letters to the editors of journals. 2 However, associations or correlations, in the absence of extremely strong population-based hazard ratios, 3 are inadequate to support a scientific conclusion of causation, without additional information supporting the likelihood of a direct causal relation in an individual case. Data limited to a few case reports make it difficult to provide informed statements about safety and appropriate precautions.…”

“…Both clinical concepts and experimental data support this and are well summarized in Zipes' discussion. 2 The most salient points are that the energy delivered by the device is sufficient to achieve transthoracic capture when delivered to the anterior chest, analogous to clinical transthoracic pacing, 7 in combination with a rate of stimulation that is sufficient to induce ventricular fibrillation. The notion that epinephrine release enhances the ability to achieve capture is supported by experimental studies, but its significance is confounded by the presence of preexisting disease that can also be influenced by epinephrine release.…”

“…2 In the absence of information that undermines the rationale for, and general usefulness of, these devices as an alternative to lethal weapons or potentially dangerous physical force, the use of these devices by law enforcement officers should not be stopped on the basis of the information provided in the report, as Zipes also notes. However, 2 policy and procedure considerations emerge very strongly from the report.…”