Document Detail


In-flight automated external defibrillator use and consultation patterns.
MedLine Citation:
PMID:  20128705     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Limited information exists about the in-flight use and outcomes associated with automated external defibrillators (AEDs) on commercial airlines.
OBJECTIVE: To describe the characteristics and outcomes of AED use during in-flight emergencies including in-flight cardiac arrest and the associated ground medical consultation patterns.
METHODS: We collected cases of AED use that were self-reported to an airline consultation service from three U.S. airlines between May 2004 and March 2009. We reviewed all available data files, related consultation forms, and recordings. For each case, demographics, initial rhythm, shock delivery/success, survival to admission, and ground medical consultation use were obtained. Success was defined as the return of a perfusing rhythm. Initial rhythms were classified as sinus, heart block, supraventricular tachycardia (SVT), atrial fibrillation/flutter, asystole, pulseless electrical activity (PEA), and ventricular fibrillation (VF)/ventricular tachycardia (VT).
RESULTS: There were a total of 169 AED applications with 40 cardiac arrests. The mean patient ages were 58 years (standard deviation [SD] 15) and 63 years (SD 12), respectively; both populations were 64% male. AEDs were applied for monitoring in 129 (76%) cases with the following initial rhythms: sinus, 114 (88%); atrial fibrillation/flutter, seven (5%); complete heart block, four (3%); and SVT, four (3%). Presenting rhythms among the cardiac arrest population were as follows: asystole, 16 (40%); VF/VT, 10 (25%); and PEA, 14 (35%). Fourteen patients were defibrillated, including nine of the 10 patients with initial VF/VT and five for the presence of VF/VT after resuscitation for initial PEA/asystole. Defibrillation was advised but not performed in the remaining case of initial VF/VT, and no medical consultation was obtained. All five successful defibrillations occurred in patients with initial VF/VT. There were six (15%; 95% confidence interval [CI] 3-27%) survivors, with five survivals occurring after successful defibrillation for initial VF/VT and one with return of a perfusing rhythm after cardiopulmonary resuscitation (CPR) for a junctional rhythm. Survival in those with VF/VT was five of 10 (50%; 95% CI 14-86%). Medications were delivered in two cases. The median time to first shock was 19 seconds (interquartile range [IQR] 12-24 seconds) after AED application. Medical consultation was obtained in 42 (33%) of the 129 AED monitoring cases and 14 (35%) of the 40 cardiac arrest cases.
CONCLUSION: Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest. Survival is poor among patients presenting with nonshockable rhythms. AEDs are used extensively for in-flight monitoring, with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests.
Authors:
Aaron Michael Brown; Jon C Rittenberger; Charles M Ammon; Scott Harrington; Francis X Guyette
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors     Volume:  14     ISSN:  1545-0066     ISO Abbreviation:  Prehosp Emerg Care     Publication Date:    2010 Apr-Jun
Date Detail:
Created Date:  2010-03-04     Completed Date:  2010-06-02     Revised Date:  2012-10-09    
Medline Journal Info:
Nlm Unique ID:  9703530     Medline TA:  Prehosp Emerg Care     Country:  England    
Other Details:
Languages:  eng     Pagination:  235-9     Citation Subset:  IM    
Affiliation:
University of Pittsburgh Affiliated Residency in Emergency Medicine, Pittsburgh, Pennsylvania 15216, USA. brownam3@upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Aviation*
Commerce*
Defibrillators / utilization*
Female
Heart Arrest / therapy
Humans
Male
Management Audit
Middle Aged
Outcome Assessment (Health Care)*
Referral and Consultation
Grant Support
ID/Acronym/Agency:
1KL2 RR024154-02/RR/NCRR NIH HHS; KL2 RR024154/RR/NCRR NIH HHS; KL2 RR024154-02/RR/NCRR NIH HHS; L30 HL090007-02/HL/NHLBI NIH HHS
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