Use, Outcomes and Policy on the Placement of Automated External Defibrillators on Commercial Aircraft for the Management of In-flight Cardiac Arrest; A Scoping Review

Patrick Sheehan,Tom Quinn

doi:10.32378/ijp.v5i1.244

Abstract

ABSTRACTIntroduction Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Some commercial aircraft carry an AED, but little is known about international policies and requirements. The aim is to review policy regarding AED placement on commercial aircraft, summarising reported incidence and outcomes of AED utilisation for individuals experiencing an in-flight cardiac arrest (IFCA).MethodsA scoping review was undertaken. Online databases (Medline and CINAHL) were searched using prespecified terms to identify reports evidencing use, outcome and policy of AEDS for IFCA on commercial aircraft. Reports were screened and data extracted following scoping review extraction methods. Data were analysed to describe incidence of AED use and outcomes following IFCA, and policies regarding AED placement on commercial aircraft.Results 9 observational studies were identified. 8 reported instances of successful shock delivery using AED. No published reports of safety incidents involving in-flight AED use were found. 7 studies reported survival following AED use: of these, 6 reported administration of a shock for IFCA survivors, whilst 1 study reported deployment of an AED without shock delivery. Overall, survival following in-flight AED use was 9%, with 37% survival reported where patients presented with shockable rhythm. Only one policy mandating AED placement on commercial aircraft was identified.ConclusionDespite the small, retrospective and observational nature of the reports identified, findings suggest in-flight AED use is feasible and associated with improved outcomes from IFCA.Keywords: cardiac arrest; defibrillators; AED; aircraft; flight

Highlights

Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest
An estimated 4.1 billion passengers per annum travel on commercial aircraft.(1) The incidence of in-flight medical emergency events are reported to account for one event per 10,000 to 40,000 passengers,(2,3) with approximately 1000 deaths occurring as a result of in-flight cardiac arrest (IFCA) on International Airlines Transport Association (IATA) carriers per year.(3) The German Society of Aerospace Medicine recently published recommendations for commercial flights, including management of IFCA, with basic life support and use of an AED.(4)
Automated external defibrillators (AED) can portably diagnose life-threatening cardiac arrhythmias such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) and administer defibrillating shocks to restore normal function of the heart.(6) AEDs are widely available and increasingly utilised, often by those with little to no training.(7) On commercial aircraft, there is an expectation that cabin crew should be trained to manage in-flight emergencies including use of an AED where available, and passengers who are health professionals, including paramedics, frequently respond to requests for assistance in such circumstances.(8) In out-of-hospital cardiac arrest (OHCA), VF presents as the initial rhythm in approximately 65% of patients.(9) VF can only be treated effectively with defibrillation and using an AED is time-critical.(10)

Summary

Introduction

Automated external defibrillators (AEDs) are increasingly available in public places for the treatment of cardiac arrest. Automated external defibrillators (AED) can portably diagnose life-threatening cardiac arrhythmias such as VF or pulseless VT and administer defibrillating shocks to restore normal function of the heart.(6) AEDs are widely available and increasingly utilised, often by those with little to no training.(7) On commercial aircraft, there is an expectation that cabin crew should be trained to manage in-flight emergencies including use of an AED where available, and passengers who are health professionals, including paramedics, frequently respond to requests for assistance in such circumstances.(8) In out-of-hospital cardiac arrest (OHCA), VF presents as the initial rhythm in approximately 65% of patients.(9) VF can only be treated effectively with defibrillation and using an AED is time-critical.(10). Precise in-flight incidence of cardiac arrest remains unknown due to a lack of a mandatory and uniform reporting system and it has been suggested that data is often unclear due to the potential ‘negativity through association’ airlines or air travel could receive.(17) Between 2008 and 2010, 11,920 reported in-flight medical emergencies suggest an incidence of 16 to 25 emergencies per million passengers, or one medical emergency every 604 flights, with a fatality rate of 0.1 to 0.3 deaths per million passengers.(18) Airline specific studies suggested that severe emergencies, including IFCAs, are increasing alongside traveller numbers, flight durations and increasing life expectancies.(19,20)

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