Use of Automated External Defibrillators by a U.S. Airline
Richard L. Page, M.D., José A. Joglar, M.D., Robert C. Kowal, M.D., Ph.D., Jason D. Zagrodzky, M.D., Lauren L. Nelson, B.S.N., Karthik Ramaswamy, M.D., Saverio J. Barbera, M.D., Mohamed H. Hamdan, M.D., and David K. McKenas, M.D., M.P.H.
Background Passengers who have ventricular fibrillation aboardcommercial aircraft rarely survive, owing to the delay in obtainingemergency care and defibrillation.
Methods In 1997, a major U.S. airline began equipping its aircraftwith automated external defibrillators. Flight attendants weretrained in the use of the defibrillator and applied the devicewhen passengers had a lack of consciousness, pulse, or respiration.The automated external defibrillator was also used as a monitorfor other medical emergencies, generally at the direction ofa passenger who was a physician. The electrocardiogram thatwas obtained during each use of the device was analyzed by twoarrhythmia specialists for appropriateness of use. We analyzeddata on all 200 instances in which the defibrillators were usedbetween June 1, 1997, and July 15, 1999.
Results Automated external defibrillators were used for 200patients (191 on the aircraft and 9 in the terminal), including99 with documented loss of consciousness. Electrocardiographicdata were available for 185 patients. The administration ofshock was advised in all 14 patients who had electrocardiographicallydocumented ventricular fibrillation, and no shock was advisedin the remaining patients (sensitivity and specificity of thedefibrillator in identifying ventricular fibrillation, 100 percent).The first shock successfully defibrillated the heart in 13 patients(defibrillation was withheld in 1 case at the family's request).The rate of survival to discharge from the hospital after shockwith the automated external defibrillator was 40 percent. Atotal of 36 patients either died or were resuscitated aftercardiac arrest. No complications arose from use of the automatedexternal defibrillator as a monitor in conscious passengers.
Conclusions The use of the automated external defibrillatoraboard commercial aircraft is effective, with an excellent rateof survival to discharge from the hospital after conversionof ventricular fibrillation. There are not likely to be complicationswhen the device is used as a monitor in the absence of ventricularfibrillation.
Source Information
From the Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (R.L.P., J.A.J., R.C.K., J.D.Z., L.L.N., K.R., S.J.B., M.H.H.); and American Airlines, Fort Worth, Tex. (D.K.M.).
Address reprint requests to Dr. Page at the Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Rm. CS7.102, 5323 Harry Hines Blvd., Dallas, TX 75390-9047, or at rpage{at}parknet.pmh.org.
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