Factors associated with sudden death of individuals requiring restraint for excited delirium

The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eigh teen cases of such deaths witnessed by emergency medical service (EMS) pers onnel are reported. The 18 cases reported were restrained with the wrists a nd ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial car diopulmonary arrest rhythm in 72% of the sudden death cases. Associated wit h all sudden death cases was struggle by the victim with forced restraint a nd cessation of struggling with labored or agonal breathing immediately bef ore cardiopulmonary arrest. Also associated was stimulant drug use (78%), c hronic disease (56%), and obesity (56%). The primary cardiac arrest rhythm of ventricular tachycardia was found in 1 of 13 victims with confirmed init ial cardiac rhythms, with none found in ventricular fibrillation, Our findi ngs indicate that unexpected sudden death when excited delirium victims are restrained in the out-of-hospital setting is not infrequent and can be ass ociated with multiple predictable but usually uncontrollable factors. (Am J Emerg Med 2001;19:187-191. Copyright (C) 2001 by W.B. Saunders Company).