Metabolic acidosis in restraint-associated cardiac arrest: a case series.
The mechanism of death in patients struggling against restraints remains a topic of debate. This article presents a series of five patients with restraint-associated cardiac arrest and profound metabolic acidosis. The lowest recorded pH was 6.25; this patient and three others died despite aggressive resuscitation. The survivor's pH was 6.46; this patient subsequently made a good recovery. Struggling against restraints may produce a lactic acidosis. Stimulant drugs such as cocaine may promote further metabolic acidosis and impair normal behavioral regulatory responses. Restrictive positioning of combative patients may impede appropriate respiratory compensation for this acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint techniques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested.
Hick
J L
JL
Department of Emergency Medicine, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis 55415, USA. john.hick@co.hennepin.mn.us
Smith
S W
SW
Lynch
M T
MT
D000138:Acidosis / Q000209:etiology*; D000328:Adult; D002423:Cause of Death; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000378:metabolism; D004636:Emergency Service, Hospital; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D012149:Restraint, Physical / Q000009:adverse effects*; D012151:Resuscitation; D014754:Violence