In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM)

Abstract

By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.

Kreislaufstillstand unter besonderen Umständen

“…Abhängig von den Platzverhältnissen im Flugzeug kann die Verwendung einer SGA für das Atemwegsmanagement bei Reanimationen während einer Flugreise anderen Maßnahmen überlegen sein [ 496 ]. Die Verwendung einer Kapnometrie kann bei einem Kreislaufstillstand während des Flugs hilfreich sein.…”

“…Die Verwendung einer Kapnometrie kann bei einem Kreislaufstillstand während des Flugs hilfreich sein. Ein (einfaches) qualitatives Kapnometer soll verfügbar sein [ 496 ].…”

“…Neben einigen allgemeinen Informationen in der Sicherheitshinweiskarte in der Sitztasche soll der Standort der Notfallausrüstung in der Sicherheitseinweisung vor dem Flug erwähnt werden 497 . Das Kabinenpersonal muss in Wiederbelebungsmaßnahmen inklusive AED-Defibrillation geschult sein und soll darin alle 6 Monate neu trainiert werden [ 496 ].…”

In-Flight Medical Emergencies

“…23 The FAA requires automated external defibrillators on all airplanes with "a maximum payload capacity of more than 7,500 pounds and with at least one flight attendant," 46 but automated external defibrillators are not currently mandated for European airlines. 48,49 The FAAmandated medical kit contains protective gloves and equipment for a basic medical assessment, hemorrhage control, and initiation of an intravenous line ( Table 3). The FAA-mandated medical kit contents also include medications to treat mild pain, allergic reactions, bronchoconstriction, hypoglycemia, dehydration, and some cardiac conditions.…”

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

“…(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) Cardiac arrest (CA) is the cessation of cardiac activity, frequently due to sustained abnormal heart arrhythmias ventricular tachycardia (VT) or ventricular fibrillation (VF). (5) By its nature, cardiac arrest can occur suddenly and unpredictably in any environment.…”