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Death Caused by Cardioinhibitory Reflex: What Experts Believe

Schrag, Bettina MD; Mangin, Patrice MD, PhD; Vaucher, Paul MSc; Bollmann, Marc D. MD

The American Journal of Forensic Medicine and Pathology: March 2012 - Volume 33 - Issue 1 - p 8–12
doi: 10.1097/PAF.0b013e3181db7efd
Original Articles

The danger of neck compression without restriction of the arterial flow remains unresolved in forensic medicine. There is an ongoing debate concerning life endangerment due to the cardioinhibitory reflex. The aim of this study was to determine what forensic medical experts believe and how they deal with this reflex. An anonymous electronic questionnaire was sent to 1429 forensic medical experts all over the world. We asked them about their opinion on the cardioinhibitory reflex, its role in causing death, and what their diagnostic criteria were.

A total of 182 questionnaires were returned. The experts who answered were from 32 different countries. Our survey showed that 80.2% of experts believe that the cardioinhibitory reflex can theoretically cause death. In the practical application opinions diverge though. Apparently, the practical application mainly depends on the habit of the individual expert. We observed no consensus on the diagnostic criteria to be used. Given the potentially frequent use of the concept of the cardioinhibitory reflex in forensic practice and its judicial impact it would be important to reach a consensus.

From the University Centre of Legal Medicine, Western Switzerland, Geneva-Lausanne, Lausanne, Switzerland.

Manuscript received September 11, 2009; accepted September 27, 2009.

Supported by the University Centre of Legal Medicine, Western Switzerland, Lausanne.

The authors report no conflicts of interest.

Reprints: Bettina Schrag, MD, Rue Michel-Servet 1, 1211 Geneva 4, Switzerland. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.