Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators.

OBJECTIVE: Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry. RESEARCH DESIGN AND METHODS AND RESULTS: A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62-0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P = 0.001). CONCLUSIONS: All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.

Electrical waterbath stunning: influence of different waveform and voltage settings on the induction of unconsciousness and death in male and female broiler chickens.

Stunning effectiveness of male and female broiler chickens was analyzed in response to different waveforms at 3 constant voltage levels. In total, 180 male and female broiler chickens were stunned using a sine wave alternating current (AC) of 50 Hz, rectangular AC of 70 Hz, and pulsed direct current (DC) of 70 Hz (duty-cycle 1:1) with a constant voltage of 60, 80, or 120 V, respectively. In each stunning group, 10 male and 10 female birds were stunned for 4 s. The current obtained by every bird was recorded. For stunning efficiency, the electroencephalogram (EEG) and physical reflexes were recorded and analyzed. The EEG was recorded for 120 s poststun. Simultaneously, the occurrence of spontaneous eye blinking, wing flapping, and breathing was assessed, and the corneal reflex was tested every 20 s poststun. The EEG was analyzed regarding the occurrence of a profound suppression to less than 10% of the prestun level in the 2 to 30 Hz and 13 to 30 Hz bands. Female broilers obtained a significantly lower stunning current compared with that of the males. This resulted in a lower stunning efficiency for females, when the same constant voltage was applied to males and females. The waveforms required different amounts of currents to achieve a 90% stunning efficiency. A minimum necessary stunning current of 70, 90, and 130 mA could be established for sine wave AC, rectangular AC, and pulsed DC, respectively. The low stunning efficiency of pulsed DC might be caused by the short stunning time of 4 s. This effect should be further investigated for DC stunning. Very few birds stunned with AC resumed breathing following stunning, indicating stun to kill. Pulsed DC stunning showed a lower effect on the induction of death. The level of wing flapping, indicating convulsions and possible meat quality defects, was higher for the AC treatments.

Electronic control device exposure: a review of morbidity and mortality.

The use of electronic control devices has expanded worldwide during the last few years, the most widely used model being the Taser. However, the scientific knowledge about electronic control devices remains limited. We reviewed the medical literature to examine the potential implications of electronic devices in terms of morbidity and mortality, and to identify and evaluate all the existing experimental human studies. A single exposure of an electronic control device on healthy individuals can be assumed to be generally safe, according to 23 prospective human experimental studies and numerous volunteer exposures. In case series, however, electronic control devices could have deleterious effects when used in the field, in particular if persons receive multiple exposures, are intoxicated, show signs of "excited delirium," or present with medical comorbidities. As the use of electronic control devices continues to increase, the controversy about its safety, notably in potentially high-risk individuals, is still a matter of debate. The complications of electronic control device exposure are numerous but often recognizable, usually resulting from barbed dart injuries or from falls. Persons exposed to electronic control devices should therefore be fully examined, and traumatic lesions must be ruled out.

Deaths in custody: are some due to electronic control devices (including TASER devices) or excited delirium?

Deaths have occurred after law-enforcement incidents involving applications of electronic control devices (ECDs) (including TASER devices). An "excited delirium" syndrome (reported in the literature prior to the development of ECDs currently in use), however, includes several factors that may be related to such deaths in custody. In this review, potential detrimental effects of ECDs are compared with possible changes due to excited delirium. Although extreme (i.e., long-duration or repeated) exposures to ECDs can result in significant hyperkalaemia, acidaemia, and myoglobinemia in animal models, limited applications (such as those normally used in law-enforcement situations) would appear to have only transient effects. In addition, the hyperthermia observed in patients with excited delirium does not seem to be directly exacerbated by ECD applications. ECD use is unlikely to be a common cause of ventricular fibrillation, but other events that are generally associated with excited delirium (e.g., drug use) may be related to subsequent ventricular fibrillation or asystole. Metabolic or respiratory acidosis may only be serious consequences of long-duration or repeated ECD applications. On the basis of current available information, factors other than ECDs themselves may be more important when death occurs after the use of ECDs.

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.

Effect of electrical stun/kill method, interval between killing and neck cutting and blood vessels cut on blood loss and meat quality in broilers.

1. Broiler chickens were killed using either an electrical waterbath (WB system) delivering 120 mA per bird (50 Hz, alternating current, AC) for 4 s or an alternative stun/kill method (ASK system); where head-only stunning for 1 s was immediately followed by head-to-body (vent) application for 1 s (150 mA, 50 Hz sine wave AC). Within each stun/kill system, the neck was cut ventrally or unilaterally 20, 60, or 180 s after killing. In addition, a control group of broilers was stunned with 100 mA per bird in a waterbath using 1500 Hz AC for 4 s and were bled by a ventral neck cut within 20 s. 2. Blood leaving the neck cut was collected for 90 s in a bin placed on an electronic balance and blood loss (g/kg body weight) calculated. 3. Individually identified, unplucked and uneviscerated carcases were held at ambient temperature until the end of the experimental day and then stored overnight in an air chiller (5 degrees C). The carcases were dissected and the incidence of broken furculum and coracoid bones, haemorrhaging in P. minor and P. major muscles, and discolouration of P. major muscles were determined. 4. When neck cutting was performed in broilers 20 s after the stun or kill, the ASK and WB systems, in comparison with high frequency stunning, produced on average about 10 g per kg less bleed out. Within the stun/kill systems, broilers killed by ASK had a greater bleed out than in the WB system. Neck cutting at 20 s or 60 s post-kill resulted in a greater bleed out than when performed after a delay of 180 s. Ventral or unilateral neck cutting resulted in a similar bleed out. 5. Stunning broilers with 1500 Hz AC resulted in lower incidences of broken bones, haemorrhaging in breast muscles and muscle discolouration post mortem than the stun/kill systems. These defects were significantly lower in the ASK than in the WB system. Delayed neck cutting increased the severity of discolouration occurring Post mortem in the breast muscles. 6. It is suggested that broilers killed by ASK can be neck cut with a delay of up to 180 s without compromising bleed out. The incidence of broken bones and haemorrhaging in breast muscles are significantly less with ASK than WB. 7. Owing to the commercial benefits and potential for improved welfare at slaughter, ASK would appear to be a better method than WB.

Carcase and meat quality in broilers either killed with a gas mixture or stunned with an electric current under commercial processing conditions.

1. Carcase and meat quality were evaluated under commercial conditions in 400 broilers either killed with a mixture of 30% carbon dioxide and 60% argon in air or stunned with a 50 Hz AC with clipped sine wave. 2. Compared with electrical stunning, killing broilers with the gas mixture eliminated or substantially reduced the prevalence of carcase and meat quality defects. 3. The results also showed that killing broilers with a mixture of 30% carbon dioxide and 60% argon would enable filleting (deboning) to be performed at 4 h post mortem without adversely affecting the cook loss or texture of breast meat.

Effect of the method of killing, interval between killing and neck cutting and blood vessels cut on blood loss in broilers.

1. Broiler chickens were killed using 90% argon in air, or 30% carbon dioxide and 60% argon in air or 120 mA per bird in a waterbath with a 50 Hz alternating electric current. Ventral or unilateral neck cutting was performed at 1, 3 or 5 min after killing. In addition, a group of broilers was stunned with 120 mA per bird in a waterbath using 1500 Hz alternating current and were bled out-with a ventral neck cut within 20 s from stunning. 2. Blood leaving the neck wound was collected in a bin placed on an electronic balance and a computer program calculated the cumulative blood loss up to 100 s after neck cutting. 3. Bleed-out was significantly affected by killing method and time of neck cutting. Broilers killed with the carbon dioxide-argon mixture bled-out less than those killed with argon or 50 Hz electric current. When compared with the 1 min neck cutting interval, a delay of 3-or 5 min resulted in a lower bleed-out. High frequency electrical stunning and ventral neck cutting within 20 s resulted in a slightly higher bleed-out than those recorded for the killing methods. However, within argon killing, a delay of 3 or 5 min in ventral or unilateral neck cutting had no significant effect on the bleed-out. In broilers killed with the carbon dioxide-argon mixture a 3 min delay in ventral neck cutting or a 5 min delay in unilateral neck cutting resulted in lower bleed-out. 4. Neck cutting of broilers within 5 min after argon killing or 3 min after killing with the carbon dioxide-argon mixture would result in a satisfactory bleed-out.

[Effect of nalorphine and naloxone on the course of electric pain shock in rabbits]. / Vliianie nalorfina i naloksina na techenie élektrobolevogo shoka u krolikov.

Electrical stimulation of the rabbit sciatic nerve resulted in the development of shock. Injection of physiological saline (1 ml, i. v.) did not change the progressive fall of the blood pressure or depression of palpitation and respiration. The animals died 135--191 min after discontinuance of the stimulation. Injection of nalorphine (0.4 mg/kg, i. v.) or naloxone (0.1 mg/kg i. v.) greatly improved the animals' condition. The blood pressure, palpitation and respiration returned to normal in 90--120 min after the injections. No lethal cases were recorded in this group of animals. It was shown in a supplementary group of animals that naloxone did not change the reserpine-produced hypotension.