A common cause of death in the United States is cardiac arrest. Because rapid defibrillation soon after a cardiac event has been shown to improve survival, there has been a significant effort on the part of the American Heart Association to increase public access to external defibrillators. In 1997, American Airlines instituted a program to place automated external defibrillators in its aircraft. The program has grown, and the company now has such devices on all of its flights. In addition, they have trained all flight attendants, through a formal process, to operate the defibrillators. Page and colleagues recently reported the clinical experience to date with this airline program.
The automated defibrillator used by the airline is a small (6 × 22 × 20 cm), lightweight (2 kg) device that is capable of delivering a nonprogressive sequence of three 150-J shocks. Two pads attached to the device are placed on the patient's chest wall and, through a recorded voice, the machine provides audible instructions to initiate a shock if the criteria for defibrillation are met. A shock is delivered when the operator presses a button on the device. Following each use of the device by airline personnel, two cardiologists reviewed the recorded data, including an electrocardiogram, and medical files maintained by American Airlines.
During a two-year period, automated defibrillators were used on 200 patients, 191 who were on the plane and nine in the airport terminal. Loss of consciousness occurred in 99 patients. The device functioned properly in 199 cases, giving the user correct information regarding the patients' cardiac rhythm. The majority of patients (n = 145) were noted to be in sinus rhythm on interrogation. In 14 cases, there was documented ventricular fibrillation, and cardioversion was recommended. The operator delivered at least one shock in 13 cases (one was withheld at the family's request), which terminated ventricular fibrillation in all of these patients. This translated to a sensitivity (14 of 14) and specificity (13 of 13) of 100 percent. Two other patients with presumed ventricular fibrillation were shocked, but recorded data for them was not available. Of the patients who survived the initial event and were hospitalized, six survived to discharge. These patients had complete functional and neurologic recovery.
The authors conclude from this data that the use of automated external defibrillators is effective and potentially life-saving, and it can be appropriately used on commercial airline flights. The excellent sensitivity and specificity for detecting lethal arrhythmias, coupled with the ease of use of these devices by non-medical personnel, is an additional advantage. The authors believe these devices should become standard equipment on all commercial airline flights.