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

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 (C) 2009 by the Society for Academic Emergency Medicine