Shocked Though the Heart and YouTube Is to Blame—The Rising Incidence of Accidental Trans-cardiac Electrocution From Do-It-Yourself Fractal Wood Art, and a Call to Action

Abstract

In the past year, we have become aware of a new mechanism of severe electrical injury ascribed to fractal wood art. This type of art has become increasingly popular and deadly due to exponential popularity in the use of Youtube type video teaching. This manuscript is one of the initial descriptions of the injury mode, presentation, treatment, and outcomes from four such cases treated at our institution. Additionally, we elicit a call for action in preventing further similar unnecessary injuries and deaths.

Increased time at home combined with a glut of do-it-yourself (DIY) instructional YouTube videos is exacerbating an alarming wood art trend responsible for multiple high-voltage electrical injuries and deaths. Known as Lichtenberg burning, the technique involves applying upwards of 20,000 volts of electricity to electrolyte-soaked wood to create artistic patterns (Figure 1). Artists use handheld jumper cables attached to a high-voltage transformer, often made from repurposed household electronics, to generate the necessary current.¹ Mishaps can result in transcardiac electrocution, with a growing number of casualties being reported across the country.² We describe the spectrum of injuries exhibited by four survivors of fractal wood art-related accidents that were treated at our institution. We also elicit a call to action from the medical community to enhance public awareness of the risks associated with this dangerous past time.

Figure 1.

Lichtenberg fractal wood burning uses high-voltage electricity to create lightening-like burn patterns in wood.

METHODS

We screened patients admitted to our institution between January 1, 2018 and June 1, 2020 that carried a diagnosis of electrical injury (ICD 10 codes: T75.4 Electrocution, W86.0XXA Exposure to domestic wiring and appliances; W85.XXXA Exposure to electric transmission lines; W86.1XXA Exposure to industrial wiring, appliance, and electrical machinery; and W86.8XXA Exposure to other electric current). Thirteen patients were identified. The medical records of these patients were then manually reviewed by two independent reviewers (R.M.R. and G.A.V.) to identify patients whose mechanism of injury was specifically described as related to the process of applying high-voltage electricity to wood to create decorative art. Four patients met these criteria.

CASES

A summary of the patient demographics, injuries, and hospital courses is given in Table 1.

Table 1.

Summary of demographic and clinical information for four survivors of fractal woodburning-related injuries at a single burn center

Age	Sex	CPR	Cardiac	Neurological	Skin/ Musculoskeletal	Renal	ICU LOS	HLOS	Interventions	Disposition
35	Male	Yes	Ventricular fibrillation arrest Transient arrythmias	Anoxic brain injury Posttraumatic amnesia Encephalopathy	Bilateral hand burns Multiple rib fractures Sternal fracture Forearm compartment syndrome Rhabdomyolysis Proximal humerus fracture	AKI	5 d	10 d	Intubation/mechanical ventilation Targeted temperature management Bilateral hand/arm fasciotomies Bilateral carpal tunnel release Split thickness skin grafting to hands Local advancement flap to thumb Surgical repair of the humerus	Home with assistance and outpatient rehabilitation
67	Male	Yes	Ventricular fibrillation arrest Non-ST segment elevation MI New-onset ischemic cardiomyopathy Transient arrythmias	Anoxic brain injury Posttraumatic amnesia Encephalopathy Dysphagia Dysphonia	Bilateral hand burns Facial lacerations	AKI	6 d	11 d	Intubation/mechanical ventilation Targeted temperature management Nasoenteric tube feeding Nuclear medicine cardiac stress test Coronary angiography	Inpatient Rehabilitation
46	Male	No	Atrial fibrillation with rapid ventricular response	Transient loss of consciousness	Bilateral hand burns Peri-orbital ecchymosis Facial laceration Zygomatic arch fracture	—	2 d	2 d	Laceration repair Surgical repair of the orbital wall	Home
27	Male	Yes	Ventricular fibrillation arrest Transient arrythmias Lasting sinus arrythmia	Transient loss of consciousness	Bilateral hand burns Knee laceration Scattered abrasions	—	1 d	1 d	Laceration repair	Home

AKI, acute kidney injury; CPR, cardiopulmonary resuscitation; HLOS, hospital length of stay; ICU LOS, intensive care unit (including step-down/telemetry) length of stay; MI, myocardial infarction.

All patients sustained transcardiac high-voltage electrical injury involving multiple organ systems with sequela of varying severity incurred while attempting to replicate YouTube videos of Lichtenberg woodburning.

Case 1

After watching YouTube videos describing fractal burning, a 35-year-old man was attempting to create Lichtenberg wood art in his garage using a transformer he adapted from a microwave oven. On his first attempt, he received an electrical shock of 20,000V across his heart. He suffered cardiac arrest witnessed by his paramedic father who immediately began cardiopulmonary resuscitation (CPR) after finding his son pulseless. Emergency Medical Services (EMS) initiated CPR with defibrillation for ventricular fibrillation until return of spontaneous circulation (ROSC) was achieved. Upon arrival at our level 1 Trauma/Burn center, physical exam revealed full-thickness burns to multiple fingers on both hands (Figure 2). Comprehensive imaging revealed bilateral nondisplaced rib fractures without pneumothorax and a manubrial fracture. He initially displayed seizure-like movements of his extremities, however, electroencephalography was negative for seizures. He remained intubated, sedated, and mechanically ventilated while undergoing targeted temperature management for 48 hours. He was treated for rhabdomyolysis and monitored for pigment-induced nephropathy. Bilateral hand fasciotomies were performed for compartment syndrome, and his burn wounds were debrided and grafted. Following extubation on hospital day (HD) 2, he remained repetitive and confused with family reporting slower than usual cognition due to electrical encephalopathy and anoxic brain injury. Neurological exam revealed motor weakness of the upper extremities. Tertiary survey revealed a fracture of the right proximal humerus that was treated with open reduction internal fixation by orthopedic surgery. He was transferred from the intensive care unit on HD 5 and was discharged from the hospital on HD 10. In the outpatient setting, 3 months after the initial event, he has made a full recovery.

Figure 2.

Full-thickness electrical burn to the hands sustained as a result of attempted Lichtenberg fractal wood burning. (A) Left first digit. (B) Right first digit. (C) Right second digit.

Case 2

patient 2 is a 67-year-old man with type 2 diabetes and hypertension. He had been studying fractal wood burning by watching instructional videos on the Internet for months and planned to make his own video. He was demonstrating the power of electricity to a group of children when he was electrocuted by his modified microwave converter while attempting Lichtenberg burning. EMS performed CPR with defibrillation for ventricular fibrillation until ROSC was achieved. Upon hospital arrival, he was treated for ventricular tachycardia and atrial fibrillation. His injuries included full-thickness electrical burns over the left index finger and right thumb, a 4-cm left supraorbital laceration and a 1.5-cm superficial laceration over the bridge of his nose. He remained intubated, sedated, and mechanically ventilated for 4 days. During that time, he completed targeted temperature management and was treated for a non-ST elevation myocardial infarction with new-onset cardiomyopathy. An echocardiogram demonstrated a left ventricular ejection fraction of 45% with focal wall motion abnormalities that resolved by HD 4. Following extubation, he was found to have post-electrocution encephalopathy with significant impairment. He was discharged to inpatient rehabilitation on HD 11 with planned follow-up with cardiology, neurology, general surgery, and ophthalmology due to increased risk of cataracts.

Case 3

patient 3 is a 46-year-old man who was employed as a professional woodworker. He and a friend were using a home-made “lightning machine” to learn the Lichtenberg fractal burning techniques they had watched on YouTube. He sustained a transcardiac electric shock causing him to lose consciousness for approximately 2 minutes. When EMS arrived, he was conscious but confused and in atrial fibrillation with rapid ventricular response. Initial evaluation at a local hospital revealed bilateral full-thickness electrical burns to the dorsal surfaces of his proximal second fingers, a right zygomatic arch fracture, and a laceration near his right eyebrow that was repaired. He was transferred to our burn center for critical care and burn management. He arrived in normal sinus rhythm with frequent premature ventricular contractions and otherwise normal vital signs. He received 24 hours of continuous cardiac monitoring revealed occasional premature ventricular contractions and bradycardia. Serum troponin measurements remained normal. He had no signs or symptoms concerning for compartment syndrome. His burns were treated with bacitracin and xeroform gauze. Neurocognitive evaluation was normal. He was discharged home on HD 2 with instructions for wound care and outpatient follow-up for his zygomatic fracture.

Case 4

After watching several instructional Internet videos demonstrating Lichtenberg wood art, patient 4 decided to try it himself. He is a 27-year-old previously healthy man who was using a microwave transformer and jumper cables when he reported experiencing electricity arc from one hand, up his arm, across his upper chest and out the other hand. He suffered a brief loss of consciousness that caused him to fall and hit his head. He was transported by EMS to a nearby hospital where he was hemodynamically stable with normal vital signs. His injuries were limited to full-thickness electrical burns on the palmar aspects of his hands and wrists with associated lacerations. He had clavicular pain without fracture or deformity, and multiple scattered abrasions. He was transferred to our burn center for continuing wound care and 24 hours of cardiac monitoring. Telemetry demonstrated no arrhythmias, and serial troponin and creatinine kinase levels were normal. He had no signs or symptoms of compartment syndrome throughout his stay. His burns were dressed with bacitracin, xeroform, gauze, and burn mesh. A laceration at the base of the left fifth finger was closed with a single suture. Neurocognitive evaluation showed no impairment so he was discharged home at the conclusion of the 24-hour observation period.

DISCUSSION

With the growing popularity of Internet-based DIY videos YouTube garnered more than 2 billion active users as of May 2019. Fast forward to 2020 and that statistic has grown by 60%. YouTube users account for more than 45% of the world’s entire online population, including more than 73% of American adults.³ Many are turning to DIY online videos to inspire new ways of passing the time. As a result, the world has seen a startling increase in DIY-related injuries. Over the past 10 years, DIY-related injuries have increased by 47% due to the wide availability of free instructional videos and DIY programming compared to the high costs of hiring a professional.⁴ DIY-related fatalities have also been on the rise, with accidental electrocution ranking third most common behind crush injuries and falls from ladders.⁵

The growing popularity of fractal wood burning is increasing the incidence high-voltage electrocutions occurring at home.⁶ The pre-eminent association for wood art in the United States, the American Association of Woodturners (AAW), has issued a policy against fractal wood burning citing more than 24 deaths attributed to the technique.² After two such deaths in Ontario, Canada, this month the Electrical Safety Authority issued a warning against the use of electrical equipment to manufacture Lichtenberg generators.⁷ A casual online search using the terms “how to fractal wood burning” and “how to Lichtenberg art” yields hundreds of results including dozens of videos. Instructions, the majority of which carry no warnings or age restrictions, describe ways to fashion a fractal art machine out of household items. These videos are frequently accompanied by links and “pop up” advertisements selling the electrical equipment necessary to build a high-voltage transformer and produce a finished work of art. While some videos depict methods to “improve safety” such as holding the electrified jumper cables with oven mitts, these methods are by no means safe.

While professionals may recognize the inherent dangers of these DIY techniques, the risks are not always obvious to viewers. Tim Carter of the Washington Post’s “Ask the Builder” column warned readers not to believe what they see on YouTube. He cautioned, “I’ve watched hundreds of YouTube videos showing the exact wrong way to do something.” ⁶ However, prior to their accidents, all of our patients believed Lichtenberg burning was safe. While their collective injuries represent a spectrum from minor to permanent disability, any of them could have easily been killed by the transcardiac shock they experienced. The widow of Matt Schmidt, a 35-year-old veteran and father of three, admitted her surprise when he was electrocuted while attempting Lichtenberg burning. The couple watched YouTube videos depicting fractal wood burning for months before he tried it. “We didn’t know it was dangerous; there were no warnings with the videos,” she said.⁸ The lack of warnings on the videos was cited by all of our patients as a contributing factor to their misconception about the safety of Lichtenberg burning. This technique was even permitted as part of a high-school shop class, resulting in near-fatal injuries to a 17-year-old boy in Utah.⁹ These men are not naive aberrations. Deaths and serious injuries have resulted from fractal wood burning attempted by home hobbyists and experienced woodworkers alike.

The patients in our case series all shared the belief that they could easily replicate the process of Lichtenburg fractal wood burning seen in the online videos without any additional instruction. Even patient 3, the professional wood worker had no previous experience working with high-voltage electricity in a professional capacity. However, a study from the University of Chicago found that “merely watching others perform can foster an illusion of skill acquisition.” ¹⁰ In their study, researchers Micheal Kardas and Ed O’Brien evaluated the perception of YouTube viewers after watching instructional videos depicting how to perform challenging skills such as dancing the moon walk or removing a tablecloth from a set table without disrupting the dishes. They found that the more people watched the DIY video the more confident they were in their ability to perform the skill, despite no practice. While viewers exhibited a dose–response boost in confidence associated with increasing views, there was no corresponding improvement in performance. The authors conclude that “avid viewers may feel prematurely inspired to attempt similar actions themselves, with tragic consequences.” In the case of fractal wood burning, even those who have successfully performed the technique for years are not exempt from fatal accidents.¹¹

To alert overconfident hobbyists to the dangers of fractal wood burning, survivors suggest a warning label be inserted before users can access video content. patient 1 stated, “If I would have known [I could die from attempting fractal burning], I never would have done it.” There appears to be a misconception that media platforms such as YouTube, Twitter, and Facebook screen content for safety. With the emergence of Covid-19, there has been a push for technology companies to take a more proactive stance to limit the spread of potentially harmful content. On May 11, 2020, Twitter announced that it would apply labels and warning messages to provide additional information alongside Tweets containing misleading information regarding Covid-19.¹² They also limit or block links to outside sources that may put people in physical harm.¹³ However, at this time, their warnings do not apply to the promotion of dangerous DIY activities such as fractal wood burning. Similarly, YouTube updated its content guidelines to limit the spread of violence and hate speech.¹⁴ However, its harmful or dangerous content policy does not address DIY instructional videos that do not directly instruct the viewer on how to kill someone.¹⁵ Facebook has taken a more hands-off approach, allowing users to decide whether or not to apply a content warning to their posts. While it is not possible, or even desirable, to flag every video depicting a potentially risky activity, it seems practical to apply a warning label to videos that could lead to instantaneous death when imitated.

A CALL TO ACTION

As evidenced by the doubling of the fractal wood burning casualties reported on the AAW’s website in the time it took to write this manuscript, we can and should do more as a community to raise awareness regarding the risks of this dangerous hobby. We should capitalize on existing efforts to preserve public safety through the inclusion of warning labels on media platforms. We must do all we can to prevent unnecessary harms from misleading Internet videos that endorse fractal burning, particularly during periods of lockdown. Deaths and injury as a result of Lichtenberg fractal wood burning are entirely preventable. We would like to join the AAW in calling for a stop to the promotion of this dangerous DIY hobby. We would urge the medical community to issue a statement calling to engage media platforms in a collaborative effort to raise awareness of the dangers of fractal wood burning. We view this manuscript as one step toward this effort.

Presented at the 42nd Annual Boswick Burn and Wound Symposium, January 25–30, 2020, Wailea, Hawaii, USA

Funding

Funding is in part from the National Heart, Lung, Blood Institute, National Institutes of Health (grant number 5K12HL13803903).

Conflict of interest statement

There are no conflicts of interests for any of the contributing authors.