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 restr aint-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 acidosi s. Stimulant drugs such as cocaine may promote further metabolic acidosis a nd impair normal behavioral regulatory responses. Restrictive positioning o f combative patients may impede appropriate respiratory compensation for th is acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint tech niques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested.