TASER Device-Induced Rhabdomyolysis is Unlikely
Article Outline
To the Editor:
We read with interest the Case Report by Sanford and colleagues of two subjects subdued by TASER devices (1). We believe that this Clinical Communication reports correctly that, in general, people with behavior rising to a certain escalated level of combativeness or agitation are more likely to be the recipients of a TASER device application for control and restraint and that they may have some underlying medical conditions that need to be further evaluated (such as intoxication, delirium, or uncontrolled psychosis).
However, we would like to point out a subtlety of this report that may be lost on the reader. At first glance, the title of the article suggests that it will be a review of complications (such as rhabdomyolysis) directly related to the use of a TASER device. However, in the article, the many other reasons for these complications are accurately discussed (such as illicit drug abuse and combative behavior). The fact that the authors did not cite numerous additional recent sources of literature examining human pathophysiology associated with TASER device exposure, and have not found them to be negatively linked, should be brought to the reader's attention (2, 3, 4, 5, 6). With regard to rhabdomyolysis as mentioned in the article's two reported cases, a TASER device does cause skeletal muscle activation and an associated expected small rise in creatine kinase (CK), but it has not been shown to cause CK elevations to the levels reported (7).
In the cases reported by Sanford et al., both subjects had mild to moderate rhabdomyolysis. This is concerning from a medical standpoint. However, we believe that the TASER device likely had little effect on contributing to or causing the magnitude of this condition. This is best pointed out by comparing Case 1 (six TASER device applications, presenting CK of 1125 units/L rising to a peak CK of 3166 units/L) and Case 2 (one TASER device application, presenting CK of 1133.9 units/L, rising to a peak CK of 8086 units/L). Although there are several factors of TASER device application to consider that are not given in this report (such as method of application, location of application, duration of total application), it is unlikely that a single TASER device application could cause a rise in CK that is 3.4 times greater than that caused by six applications in succession.
Prior work by Ho et al. demonstrates that a single TASER device exposure over a large skeletal muscle mass elevates CK in humans, on average, < 100 units/L above baseline (7). There is also literature to support the idea that the factors such as active behavior of the subject, hyperthermia, or drug intoxication are much more likely to be the causes of significant rhabdomyolysis, and much of this has been known for decades (8, 9, 10, 11). This is also supported by Bozeman et al.'s recent publication describing a case of major rhabdomyolysis (CK 61,116 units/L) in a patient after significant physical exertion and cocaine use and only three TASER device applications, in contrast to the current case of six applications with a CK peak of 8086 units/L (12).
The causative variables in all of these cases do not seem to include the TASER device application when considered in the realm of the other existing situational factors and available human research data. We believe that the conditions of significant rhabdomyolysis, as described in cases such as this, are most likely attributable to illicit stimulant use and volitional combative and resistive physical behavior.
References
- . Two patients subdued with a TASER® device: cases and review of complications. J Emerg Med. 2008;April 23 [Epub ahead of print]
- Respiratory effect of prolonged electrical weapon application on human volunteers. Acad Emerg Med. 2007;14:197–201
- . Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Emerg Med. 2009;27:413–418
- . Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion. Forensic Sci Int. 2009;190:80–86
- Physiological effects of a conducted electrical weapon on human subjects. Ann Emerg Med. 2007;50:569–575
- . Rhabdomyolysis. In: Kroll MW, Ho JD editor. TASER conducted electrical weapons: physiology, pathology and law. New York: Springer; 2009;p. 163–166
- . Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults. Acad Emerg Med. 2006;13:589–595
- . Exercise-induced rhabdomyolysis. Ann Emerg Med. 1994;23:1301–1306
- . Exertional rhabdomyolysis. N Engl J Med. 1972;287:927–929
- . Acute exertional rhabdomyolysis: a syndrome of increasing importance to the military physician. Mil Med. 1974;139:33–36
- . Incidence of cocaine-associated rhabdomyolysis. Ann Emerg Med. 1991;20:154–157
- . Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med. 2008;53:480–489
Drs. Ho and Dawes serve as expert medical consultants to TASER International, Inc. (Scottsdale, AZ) and have been involved extensively in human research studies of TASER devices. Some of this research has been partially funded by TASER International, Inc.
PII: S0736-4679(10)00016-8
doi:10.1016/j.jemermed.2009.08.068
© 2011 Elsevier Inc. All rights reserved.
Refers to article:
- Two Patients Subdued with a TASER® Device: Cases and Review of Complications , 25 April 2008
