Exploding e-cigarettes lead to 100% quit rate

E-cigarettes can sometimes explode, leading to burn injuries that most commonly affect the thighs, hands, and genitalia of men, according to a retrospective review of patients admitted for e-cigarette burns at the Massachusetts General Hospital Burn Center, Boston, MA. When the researchers asked these patients about cessation, 100% reported their intention to quit smoking upon discharge. The researchers recently published their findings online in Burns.

“As the decline of traditional cigarette smoking continues, physicians may be faced with an increased incidence of rate of allergic, thermal, ballistic, and chemical injuries from e-cigarettes,” wrote corresponding author Sean Hickey, MD, and coauthors at Massachusetts General Hospital’s Sumner Redstone Burn Center.

Wait, did they say “ballistic”? Yes, ballistic. Lithium-ion batteries that power e-cigarettes pose a risk of ignition that can blast like a rocket. Dr. Hickey and colleagues described an e-cigarette (or “vape pen”) as a sealed cylindrical device that’s structurally weakest at each end. “As the battery ignites, pressure within the device builds, leading to rupture at the device’s end, causing a directed stream of energy that can propel the device” like a missile, they wrote.

But when an e-cigarette is carried in a pocket or hand, “vented exhaust obtains directionality as the battery ignites. This type of blast supports the findings on physical exam of patients with e-cigarette burns [that are] characterized by deep second-degree wounds, with punctate areas of full thickness injury that penetrates deeply into fat and muscle,” the authors described.

Men suffer disproportionately more injuries than women because men typically carry the device in their pocket while women tend to keep it in their purse, the researchers reasoned.

Their retrospective review identified 14 patients treated between January 2015 to April 2017 for injuries associated with e-cigarettes:

• 57% had second- and third-degree burns within the same wound bed
• 29% had deep second-degree burns
• 14% had superficial second-degree burns
• 93% of patients were men
• Average age was 28.6 years, ranging from 19–50 years
• 86% of injuries occurred when the device or battery was in a pants pocket, 7% in a hand, and 7% in a purse
• 43% of patients had burns isolated in the lower extremities, 21% had both lower extremity and hand burns, and 7% had burns in the upper extremities
• 29% of patients had multiple burn injuries at differing locations involving the thigh, buttock, genitalia, and/or hand
• Bilateral buttock injuries were associated with carrying the device or battery in a back pants pocket (2 of 14 patients), while genital burns were associated with carrying it in the front pants pocket (2 of 14 patients).
• 9 of 14 patients required an operating room procedure under general anesthesia
• 8 of 14 patients required skin grafting for definitive wound closure
• Average length of hospital stay was 6.6 days, ranging from 0–15 days
• Average time to 95% wound closure was 18.4 days, ranging from 8–40 days

“Of the 9 patients assessed on their intentions to quit e-cigarette smoking, 100% of patients reported their intention to quit smoking upon discharge,” the authors noted.

So, why do these battery failures occur? “It is believed that e-cigarette battery explosions are caused either by a short circuit via metallic objects such as coins and keys, or that the moist environment of the pocket promotes ‘thermal runaway’ leading to battery failure,” Dr. Hickey and coauthors wrote.

“The consumer should understand that an e-cigarette and/or e-cigarette battery should be carried separately from loose conductive objects such as keys or coins, and as far away from the body as possible during transport,” they advised.