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Previous Volume 343:1210-1216 October 26, 2000 Number 17 Next

	Full Text PDF Editorial by Robertson, R. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Passengers who have ventricular fibrillation aboard commercial aircraft rarely survive, owing to the delay in obtaining emergency care and defibrillation.

Methods In 1997, a major U.S. airline began equipping its aircraft with automated external defibrillators. Flight attendants were trained in the use of the defibrillator and applied the device when passengers had a lack of consciousness, pulse, or respiration. The automated external defibrillator was also used as a monitor for other medical emergencies, generally at the direction of a passenger who was a physician. The electrocardiogram that was obtained during each use of the device was analyzed by two arrhythmia specialists for appropriateness of use. We analyzed data on all 200 instances in which the defibrillators were used between June 1, 1997, and July 15, 1999.

Results Automated external defibrillators were used for 200 patients (191 on the aircraft and 9 in the terminal), including 99 with documented loss of consciousness. Electrocardiographic data were available for 185 patients. The administration of shock was advised in all 14 patients who had electrocardiographically documented ventricular fibrillation, and no shock was advised in the remaining patients (sensitivity and specificity of the defibrillator 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 shock with the automated external defibrillator was 40 percent. A total of 36 patients either died or were resuscitated after cardiac arrest. No complications arose from use of the automated external defibrillator as a monitor in conscious passengers.

Conclusions The use of the automated external defibrillator aboard commercial aircraft is effective, with an excellent rate of survival to discharge from the hospital after conversion of ventricular fibrillation. There are not likely to be complications when the device is used as a monitor in the absence of ventricular fibrillation.

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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• England, H., Weinberg, P. S., Estes, N. A. M. III (2006). The Automated External Defibrillator: Clinical Benefits and Legal Liability. JAMA 295: 687-690 [Full Text]  
• (2005). Part 3: Overview of CPR. Circulation 112: IV-12-IV-18 [Full Text]  
• (2005). Part 3: Defibrillation. Circulation 112: III-17-III-24 [Full Text]  
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• Kyller, M., Johnstone, D. (2005). A 2-Tiered Approach to In-Hospital Defibrillation: Nurses Respond to a Trial of Using Automated External Defibrillators as Part of a Code-Team Protocol. Crit Care Nurse 25: 25-33 [Full Text]  
• Ewy, G. A. (2005). Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation. Circulation 111: 2134-2142 [Full Text]  
• Myerburg, R. J., Estes, N.A. M. III, Fontaine, J. M., Link, M. S., Zipes, D. P. (2005). Task Force 10: Automated external defibrillators. J Am Coll Cardiol 45: 1369-1371 [Full Text]  
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• The Public Access Defibrillation Trial Investigato, (2004). Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest. NEJM 351: 637-646 [Abstract] [Full Text]  
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• Caffrey, S. L., Willoughby, P. J., Pepe, P. E., Becker, L. B. (2002). Public Use of Automated External Defibrillators. NEJM 347: 1242-1247 [Abstract] [Full Text]  
• Engdahl, J. (2002). Outcome after cardiac arrest outside hospital. BMJ 325: 503-504 [Full Text]  
• Pell, J. P, Sirel, J. M, Marsden, A. K, Ford, I., Walker, N. L, Cobbe, S. M (2002). Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 325: 515-515 [Abstract] [Full Text]  
• Joglar, J. A., Page, R. L. (2002). Automated External Defibrillator Use by Police Responders: Where Do We Go From Here?. Circulation 106: 1030-1033 [Full Text]  
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• Gendreau, M. A., DeJohn, C. (2002). Responding to Medical Events during Commercial Airline Flights. NEJM 346: 1067-1073 [Full Text]  
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• Takata, T. S., Page, R. L., Joglar, J. A. (2001). Automated External Defibrillators: Technical Considerations and Clinical Promise. ANN INTERN MED 135: 990-998 [Abstract] [Full Text]  
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• Felberg, R. A., Krieger, D. W., Chuang, R., Persse, D. E., Burgin, W. S., Hickenbottom, S. L., Morgenstern, L. B., Rosales, O., Grotta, J. C. (2001). Hypothermia After Cardiac Arrest: Feasibility and Safety of an External Cooling Protocol. Circulation 104: 1799-1804 [Abstract] [Full Text]  
• Groeneveld, P. W., Kwong, J. L., Liu, Y., Rodriguez, A. J., Jones, M. P., Sanders, G. D., Garber, A. M. (2001). Cost-effectiveness of Automated External Defibrillators on Airlines. JAMA 286: 1482-1489 [Abstract] [Full Text]  
• Eisenberg, M. S., Mengert, T. J. (2001). Cardiac Resuscitation. NEJM 344: 1304-1313 [Full Text]  
• Zipes, D. P. (2001). Implantable Cardioverter-Defibrillator: A Volkswagen or a Rolls Royce : How Much Will We Pay To Save A Life?. Circulation 103: 1372-1374 [Full Text]  
• Jaffe, A., Landau, W. M., Wetzel, R. D., Groh, W. J., Salive, M. E., Richardson, L. D., The Public Access Defibrillation Trial Investigato, , Fried, R. E., Bassan, M., Valenzuela, T. D., Page, R. L., Kowal, R. C., McKenas, D. K. (2001). Automated External Defibrillators. NEJM 344: 771-773 [Full Text]  
• Marenco, J. P., Wang, P. J., Link, M. S., Homoud, M. K., Estes III, N. A. M. (2001). Improving Survival From Sudden Cardiac Arrest: The Role of the Automated External Defibrillator. JAMA 285: 1193-1200 [Abstract] [Full Text]  
• (2001). Automated External Defibrillators Are Safe and Effective Outside the Hospital. Journal Watch Cardiology 2001: 1-1 [Full Text]  
• (2000). Good Results with Rapid Defibrillation Outside the Hospital. Journal Watch Dermatology 2000: 7-7 [Full Text]  
• (2000). Placing AEDs in Public Places Saves Lives. JWatch Emergency Med. 2000: 13-13 [Full Text]  
• (2000). Good Results with Rapid Defibrillation Outside the Hospital. JWatch General 2000: 4-4 [Full Text]  
• Valenzuela, T. D., Roe, D. J., Nichol, G., Clark, L. L., Spaite, D. W., Hardman, R. G. (2000). Outcomes of Rapid Defibrillation by Security Officers after Cardiac Arrest in Casinos. NEJM 343: 1206-1209 [Abstract] [Full Text]  
• Robertson, R. M. (2000). Sudden Death from Cardiac Arrest -- Improving the Odds. NEJM 343: 1259-1260 [Full Text]