Three Part Question
In [adult ED patients receiving a Taser discharge] is [monitoring] necessary [to detect cardiac dysrhythmias].
A 25 year old patient is subdued by law enforcement with the use of a Taser device. He is brought to your Emergency Department for further evaluation. You would like to know what type of cardiac monitoring is necessary (and for how long).
Ovid MEDLINE(R) 1950 to June Week 1 2009, Embase 1980 to 2009 Week 23 using multifile searching:
[(exp stun gun.mp or taser.mp or electromuscular incapacitation device.mp or electrical weapon.mp or energy device.mp) AND (exp arrhythmias, cardiac/ or cardiac.mp or arrhythmia.mp or exp monitoring, physiologic/ or monitoring.mp or exp electrocardiography/)]. LIMIT to human AND English.
The Cochrane Library Issue 2 2009: (taser):ti,ab,kw OR (stun gun):ti,ab,kw OR (electrical weapon):ti,ab,kw 1 record 0 relevant
34 unique papers were found of which 4 were relevant to the three part question.
|Author, date and country
||Study type (level of evidence)
|Vilke GM et al,|
|32 healthy volunteer subjects receiving a Taser X26 discharge||Prospective observational||Minor changes in heart rate, PR and QT interval||No clinically relevant ECG changes||Unable to continuously monitor subjects with a 12 lead monitor. Changes may have resolved by one minute.
Subjects were generally healthy and free of disease, which may not mimic true population.
Duration of Taser activation was limited to 5 seconds, which may not represent what occurs in the field.|
|Ho JD et al,|
|66 Human subjects after standard conducted electrical weapon application|
32 underwent ECG assessment
|Prospective observational||Troponin elevations||One subject had a troponin of 0.6 ng/ml. no evidence of acute myocardial infarction found||Study population may not be reflective of general population.
Resting population may not be representative of true agitated or stressed population.
Single, five second application of CEW may not be representative of true events in the field. |
|ECG||No changes noted|
|Levine SD et al,|
|Humans with voluntary exposure to Taser X 26||Prospective observational||Changes in heart rate and QT interval||No significant changes||Relatively small sample size.
Single lead electrocardiographic data. 12 lead might provide more accurate tracings.
Healthy patient population at rest is not representative of the true population of Taser victims.
Single 5 second shock may not be representative of what occurs in the field.
There was also significant motion artifact during the shock itself, which may obscure momentary dysrhythmias.|
|Ho JD et al,|
|33 adult male volunteers underwent a 10 second Taser discharge placed across the ideal cardiac axis (right upper sternum to the apex)|
11 of 33 had significant medical problems requiring medication
|Observational||Echocardiography||No dysrhythmias noted||Movement artefact meant that echocardiographic view was poor in 38.3% (12/33) of subjects during the actual Taser discharge|
There is a theoretical concern that administration of a conducted electrical weapon or Taser has the potential to cause significant cardiac dysrhythmias and possibly sudden death. These four studies, by means of cardiac monitoring and measurement of skin-to-heart distance, assess for the potential for induction of dysrhythmias and cardiac damage. There are several common limitations of these studies, including selection bias of healthy subjects. Another common weakness is single firing and discharges less than five seconds, which may not be representative of true events in the field. Larger studies are needed, as well as studies involving a better representation of the physiologic state of typical Taser victims.
Clinical Bottom Line
Based on the current evidence, however, it appears that no further cardiac evaluation is necessary in patients with a normal sinus rhythm in the Emergency Department after receiving a Taser discharge.
- Vilke GM. Sloane C. Levine S. Neuman T. Castillo E. Chan TC. Twelve-lead electrocardiogram monitoring of subjects before and after voluntary exposure to Taser X26. The American Journal of Emergency Medicine 26(1):1-4, 2008 Jan.
- Ho JD. Miner JR. Lakireddy DR. Bultman LL. Heegaard WG. Cardiovascular and Physiologic Effects of Conducted Electrical Weapon Discharge in Resting Adults. Academic Emergency Medicine 13(6):589-95, 2006 Jun.
- Levine SD. Sloane CM. Chan TC. Dunford JV. Vilke GM. Cardiac monitoring of human subjects exposed to Taser. Journal of Emergency Medicine 33(2):113-7, 2007 Aug.
- Ho JD, Dawes DM, Reardon RF, Lapine AL, Dolan BJ. Lundin EJ, Miner JR. Echocardiographic evaluation of a TASER-X26 application in the ideal human cardiac axis. Acad Emerg Med 2008;15:838-44.