Cardiac Arrest in a Young Patient Triggered due to Pepper Spray: A Case Report

Case Report

Austin Crit Care J. 2019; 6(1): 1026.

Cardiac Arrest in a Young Patient Triggered due to Pepper Spray: A Case Report

Arora N*

1Hospital Dr, CE 545, Columbia MO 65212, USA

*Corresponding author: Niraj Arora, 1 Hospital Dr, CE 545, Columbia MO 65212, USA

Received: April 15, 2019; Accepted: May 22, 2019; Published: May 29, 2019


Pepper spray is commonly used agent used by defense personnel. Active component Capsiacin has not been proven to cause cardiac arrest. Here, we report a case where exposure to pepper spray triggered cardiac arrest in a healthy young patient. The case description is followed by review of the systemic effects of pepper spray and a possible mechanism of arrhythmias.


Pepper spray is a common agent used for self-defense training in policing, riot control or crowd control [1,2]. The active component Oleoresin Capsicum causes local inflammatory response at the point of contact. The effect is usually transient without significant systemic effects. Here we report a case of young male with no previous cardiorespiratory co-morbidity in whom exposure to pepper spray triggered cardiac arrest. This is the first case to our knowledge documenting the effect of pepper spray in causing cardiac arrest due to ventricular fibrillation.


21 year old male with no past medical history presented to the emergency department in cardiac arrest. Patient had competed in a police training pepper spray event and decontamination at the police academy without issues with no obvious distress per witnesses. Immediately after the event, he collapsed and become unresponsive. Patient was foaming at the mouth with generalized shaking without loss of bowel or bladder at the time. He had absent pulses and so Cardiopulmonary Resuscitation (CPR) was started. When paramedics arrived on the scene, he received DC cardioversion three times, intravenous epinephrine and amiodarone without Return of Spontaneous Circulation (ROSC). Intubation was unsuccessful in the field. At the Emergency Department, CPR was continued with several DC cardioversion attempts along with intravenous epinephrine, amiodarone, lidocaine, calcium, magnesium, and bicarbonate. He achieved ROSC after a total 35 minutes of CPR. Glasgow Coma Scale (GCS) was 9 after ROSC. He was started on lidocaine drip and intubated and sedated. CT head showed no acute abnormality. Acute Kidney Injury (AKI) and lactic acidosis improved with intravenous hydration. Bedside echocardiogram on admission. (Day 1) showed severe global hypokinesis of left ventricle with Ejection Fraction (EF) 5%. CT chest showed no evidence of pulmonary emboli. Neurology evaluation revealed bilateral pupils 3mm reactive to light, corneal reflex intact, cough and gag reflex present, no spontaneous motor movements. Electroencephalogram (EEG) did not show seizure activity.

Day 2-4

Repeat echocardiogram showed moderate improvement of EF to 29. Left heart catheterization done on day 3 showed normal coronary arteries. MRI brain done on day 3 showed findings consistent with hypoxic/anoxic brain injury, worst in the bilateral occipital lobes, caudate heads (Figure 1). Day 4, patient started having intermittent rigid spasms of truncal region with dystonic arch like posturing, related to tactile stimuli. Levetiracetam was started with no response and there was no EEG correlate for these episodes.

Citation: Arora N. Cardiac Arrest in a Young Patient Triggered due to Pepper Spray: A Case Report. Austin Crit Care J. 2019; 6(1): 1026.