Cardiac Arrest and Death Attributable to the “Diving Response” Triggered During Incision and Debridement of an Abscess of the Forehead

The authors discuss about a patient who, while undergoing a routine procedure to drain a subcutaneous abscess within his forehead, suffered cardiac arrest that we conclude was caused by an activation of the diving response. This reflex affects homeostatic function which alters respiration and preferentially distributes oxygen stores to the heart and brain. Under some conditions, however, this reflex can also trigger cardiovascular collapse and death. The diving reflex is can begin with triggering receptors that are sensitive to cold water, submersion, or pressure within the nasal cavity and other areas supplied by the trigeminal nerve. Studies have shown that this afferent response primarily involves branches of the infraorbital nerve and the anterior ethmoidal nerve. However, other more superior nerves such as those exclusive to the forehead region may also be involved. This study demonstrates for the first time the risks and dangers involved in surgical procedures or manipulation of the trigeminal innervated areas of the human face and in particular the forehead. Address correspondence and reprint requests to Steven M. Kane, MD, 320 Parkway Drive NE, Suite 300, Atlanta, GA 30312; E-mail: Steve.Kane@wellstar.org Received 20 December, 2017 Accepted 14 February, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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