Sudden Cardiac Death: Mysteries Persist Despite New Study

Print Friendly, PDF & Email

Results of a new study of sudden cardiac death suggest that some of the mysteries surrounding arrest-related fatalities are likely to remain unanswered for the foreseeable future and perhaps should simply be accepted as falling among unfortunate medical occurrences that often have no ready explanations.

“Cases of SCD [sudden cardiac death] associated with altercation and restraint receive mass media attention especially when police [or] other governmental bodies are involved,” the research team notes.

But their findings about this phenomenon beg the question posed by one independent expert: Is it fair to hold law enforcement to unrealistic standards of prevention when there are so few certainties about how and why sudden deaths occur proximate to arrest?

PUZZLE OF YOUTH

The new study, reported in the journal Medicine, Science and Law, was conducted by four researchers associated with the medical school at Aristotle University in Greece and St. George’s Medical School in London. Their aim was to further clarify the “well-established association” between both chronic and acute psychological stress and heart problems that may contribute to SCD.

In older subjects, they explain, underlying coronary artery disease is often identified as an influential factor. But SCD “is becoming increasingly recognized” among younger subjects, including those in the age range most commonly associated with police encounters. And in this group there “mainly [seems to be an] absence of coronary artery disease.”

So what “associations and causes” may be driving stress-related SCD in this population? The researchers hoped to find out.

SUBJECT PARTICULARS

From a database of 2,400 SCD cases maintained at a cardiac pathology center in England, they thoroughly examined 110 instances of sudden death. The majority (over 80%) of subjects were male, the more vulnerable and combative gender, and nearly 60% were under age 35. Findings:

  • Overall, about six in 10 “died instantaneously during [a] stressful event.” The rest succumbed within 30 minutes after the event, with their stressed condition noticeable in the interim.
  • “The main circumstances of SCD,” the team found, were altercation (over 45%), struggling during restraint (31%), and merely being in police custody (10%). Lesser stressors included “receiving bad news,” “exams/school/job stress,” and “collapsing after a minor car accident.”
  • In nearly half the cases, restraint was imposed by LEOs. But at about the same collective rate, restraint was applied by non-LE personnel: psychiatric staff, security staff, or friends.
  • For the most part (90%), toxicology reports for drugs and/or alcohol were negative.

WHY’D THEY DIE?

The researchers report that 20% of the victims “had a psychiatric history and were on psychotropic drugs, and it is well established that such patients have a higher incidence of sudden death.” Indeed, psychiatric patients are believed to be five times more likely to experience SCD than people generally, and “exposure to antipsychotic drugs further exacerbates this risk even at low doses.”

Still, specific causation, especially among younger victims, seems to remain unclear. One member of the team performed a pathological analysis of each subject’s heart. “The single most common finding”: 60% had a heart that was “normal,” including the majority of those younger than 35. Where abnormality of the heart muscle was discovered, this defect was concentrated predominately in older subjects. Similarly, all cases of coronary artery disease were in older subjects, with an average age of 60.

Without drawing specific conclusions, the researchers describe several possible influences among youthful victims with normal hearts, including a genetic predisposition to disrupted heart rhythm in the presence of “intense adrenalin activation” and an overwhelmingly negative “connection between the heart and the brain” incited by a psychological reaction to acute stress (being “scared to death,” in effect).

As to definitive cause, though, the researchers report only vaguely: “[T]he mechanism of sudden death under stress may be multifactorial, resulting from a cascade of predisposing risk factors, including underlying cardiac disease, obesity, mental health, alcohol and/or drug use as well as physical exertion.”

In high-profile cases, they recommend a “thorough autopsy with toxicology” conducted by an expert in cardiac pathology as the best hope of establishing “the correct cause of death” and shielding police and/or medical personnel from unwarranted blame.

AN EXPERT’S OBSERVATIONS

This study was brought to the attention of Force Science News by Dr. Mark Kroll, adjunct professor of biomedical engineering at the University of Minnesota and Cal Poly University in California, who lectured on the science of arrest-related deaths at the latest ILEETA annual training conference. Kroll offers some pertinent observations for law enforcement:

  • “Being arrested is a highly emotional event, and the exertion of a struggle is several fold greater than that seen with normal exercise. To drive home the ability of extreme emotional stress to cause sudden death, consider that 4% of the deaths studied were caused by receiving news of a loved one’s death, 7% were due to stress from examinations or a job, and 4% were from the stress of a minor car accident without major injuries”–events unrelated to any law enforcement involvement.
  • “Annually, there are about 800,000 cases in which force is used by law enforcement in North America and approximately 800 arrest-related deaths (ARDs), yielding a mortality rate of about 1:1000–remarkably low, given the risks and stress involved. This can be compared to an in-hospital death rate of 1:232 for treatment of a common heart disorder [ablation for atrial fibrillation] by medical professionals–far higher than that for ARDs.”
  • “No matter how careful LEOs are, there will continue to be occasional ARDs. It is not clear that anything can be done to significantly reduce the risk of this below the present low rate. Is it even fair to expect law enforcement to achieve mortality rates even further below those of common hospital procedures when dealing with subjects who are often violent, disturbed, and intoxicated?”
  • “An autopsy report by a medical examiner is often the primary factor in LEO discipline, termination, civil lawsuits, and criminal prosecutions. An individual ME will see an ARD every 10 years on average. Yet society expects MEs and coroners to always reach a cause and contribution to death conclusively.

“This is impossible since numerous studies find that 25-53% of sudden deaths in children, military recruits, and athletes cannot be explained. As this new study shows, this syndrome often has no clear pathological mechanism or no obvious anatomical or toxicological basis.

“Hopefully, someday society will accept the diagnosis of ‘arrest-related death syndrome’ without forcing the medical examiner to always find some deadly condition which is not necessarily there to be found.”

FALSE THEORY CORRECTED

Kroll cites a “small weakness” in the new paper: The researchers mention “so-called compression/positional asphyxia as possibly contributing to restraint deaths.” This “dying, unscientific theory” has been thoroughly discredited by “a substantial number of peer-reviewed studies” showing that positioning of arrestees has little or no impact on a suspect’s ability to breathe, Kroll states. He and two colleagues have published a letter of correction in the journal.

A free abstract of the study, “Sudden cardiac death with stress and restraint,” can be accessed by clicking here. The full study is available for a fee. The letter disputing the validity of so-called positional asphyxia is available without charge by clicking here

Leave a Reply

GDPR

  • Privacy Policy

Privacy Policy

Effective date: January 06, 2019

Force Science Institute, Ltd. (“us”, “we”, or “our”) operates the https://www.forcescience.org/ website (hereinafter referred to as the “Service”).

This page informs you of our policies regarding the collection, use, and disclosure of personal data when you use our Service and the choices you have associated with that data. Our Privacy Policy for Force Science Institute, Ltd. is based on the Privacy Policy Template from Privacy Policies.

We use your data to provide and improve the Service. By using the Service, you agree to the collection and use of information in accordance with this policy. Unless otherwise defined in this Privacy Policy, the terms used in this Privacy Policy have the same meanings as in our Terms and Conditions, accessible from https://www.forcescience.org/

Information Collection And Use

We collect several different types of information for various purposes to provide and improve our Service to you.

Types of Data Collected

Personal Data

While using our Service, we may ask you to provide us with certain personally identifiable information that can be used to contact or identify you (“Personal Data”). Personally identifiable information may include, but is not limited to:

  • Email address
  • First name and last name
  • Phone number
  • Address, State, Province, ZIP/Postal code, City
  • Cookies and Usage Data

Usage Data

We may also collect information on how the Service is accessed and used (“Usage Data”). This Usage Data may include information such as your computer’s Internet Protocol address (e.g. IP address), browser type, browser version, the pages of our Service that you visit, the time and date of your visit, the time spent on those pages, unique device identifiers and other diagnostic data.

Tracking & Cookies Data

We use cookies and similar tracking technologies to track the activity on our Service and hold certain information.

Cookies are files with small amount of data which may include an anonymous unique identifier. Cookies are sent to your browser from a website and stored on your device. Tracking technologies also used are beacons, tags, and scripts to collect and track information and to improve and analyze our Service.

You can instruct your browser to refuse all cookies or to indicate when a cookie is being sent. However, if you do not accept cookies, you may not be able to use some portions of our Service. You can learn more how to manage cookies in the Browser Cookies Guide.

Examples of Cookies we use:

  • Session Cookies. We use Session Cookies to operate our Service.
  • Preference Cookies. We use Preference Cookies to remember your preferences and various settings.
  • Security Cookies. We use Security Cookies for security purposes.

Use of Data

Force Science Institute, Ltd. uses the collected data for various purposes:

  • To provide and maintain the Service
  • To notify you about changes to our Service
  • To allow you to participate in interactive features of our Service when you choose to do so
  • To provide customer care and support
  • To provide analysis or valuable information so that we can improve the Service
  • To monitor the usage of the Service
  • To detect, prevent and address technical issues

Transfer Of Data

Your information, including Personal Data, may be transferred to — and maintained on — computers located outside of your state, province, country or other governmental jurisdiction where the data protection laws may differ than those from your jurisdiction.

If you are located outside United States and choose to provide information to us, please note that we transfer the data, including Personal Data, to United States and process it there.

Your consent to this Privacy Policy followed by your submission of such information represents your agreement to that transfer.

Force Science Institute, Ltd. will take all steps reasonably necessary to ensure that your data is treated securely and in accordance with this Privacy Policy and no transfer of your Personal Data will take place to an organization or a country unless there are adequate controls in place including the security of your data and other personal information.

Disclosure Of Data

Legal Requirements

Force Science Institute, Ltd. may disclose your Personal Data in the good faith belief that such action is necessary to:

  • To comply with a legal obligation
  • To protect and defend the rights or property of Force Science Institute, Ltd.
  • To prevent or investigate possible wrongdoing in connection with the Service
  • To protect the personal safety of users of the Service or the public
  • To protect against legal liability

Security Of Data

The security of your data is important to us, but remember that no method of transmission over the Internet, or method of electronic storage is 100% secure. While we strive to use commercially acceptable means to protect your Personal Data, we cannot guarantee its absolute security.

Service Providers

We may employ third party companies and individuals to facilitate our Service (“Service Providers”), to provide the Service on our behalf, to perform Service-related services or to assist us in analyzing how our Service is used.

These third parties have access to your Personal Data only to perform these tasks on our behalf and are obligated not to disclose or use it for any other purpose.

Analytics

We may use third-party Service Providers to monitor and analyze the use of our Service.

  • Google AnalyticsGoogle Analytics is a web analytics service offered by Google that tracks and reports website traffic. Google uses the data collected to track and monitor the use of our Service. This data is shared with other Google services. Google may use the collected data to contextualize and personalize the ads of its own advertising network.You can opt-out of having made your activity on the Service available to Google Analytics by installing the Google Analytics opt-out browser add-on. The add-on prevents the Google Analytics JavaScript (ga.js, analytics.js, and dc.js) from sharing information with Google Analytics about visits activity.For more information on the privacy practices of Google, please visit the Google Privacy & Terms web page: https://policies.google.com/privacy?hl=en

Links To Other Sites

Our Service may contain links to other sites that are not operated by us. If you click on a third party link, you will be directed to that third party’s site. We strongly advise you to review the Privacy Policy of every site you visit.

We have no control over and assume no responsibility for the content, privacy policies or practices of any third party sites or services.

Children’s Privacy

Our Service does not address anyone under the age of 18 (“Children”).

We do not knowingly collect personally identifiable information from anyone under the age of 18. If you are a parent or guardian and you are aware that your Children has provided us with Personal Data, please contact us. If we become aware that we have collected Personal Data from children without verification of parental consent, we take steps to remove that information from our servers.

Changes To This Privacy Policy

We may update our Privacy Policy from time to time. We will notify you of any changes by posting the new Privacy Policy on this page.

We will let you know via email and/or a prominent notice on our Service, prior to the change becoming effective and update the “effective date” at the top of this Privacy Policy.

You are advised to review this Privacy Policy periodically for any changes. Changes to this Privacy Policy are effective when they are posted on this page.

Contact Us

If you have any questions about this Privacy Policy, please contact us:

  • By email: [email protected]
  • By visiting this page on our website: https://www.forcescience.org/contact
  • By phone number: 866-683-1944
  • By mail: Force Science Institute, Ltd.