Defibrillation aboard a commercial aircraft.

A 53-year-old executive (6 ft 3 in tall; 327 lb) with a history of diabetes mellitus, hypertension, and coronary artery disease (coronary artery angioplasty in 1995) was traveling with his wife on vacation and ran to catch a connecting flight. The plane had closed the doors for takeoff when his wife noted that he was unresponsive. A flight attendant brought out the on-board automatic external defibrillator (AED; “ForeRunner,” Heartstream) and was assisted by a passenger with paramedic training. The device was applied and successfully defibrillated the patient with a single 130-J biphasic shock (see Figure). The patient regained pulse and blood pressure and was never intubated. His first blood pressure measurement was 150/92 mm Hg. He was transferred to a nearby hospital, where myocardial infarction was ruled out by serial creatine phosphokinase and troponin I measurements. He underwent cardiac catheterization (which revealed severe 3-vessel disease with preserved left ventricular function) and coronary artery bypass graft surgery. An implantable cardioverter-defibrillator was implanted because of concern that poor distal vessels had made the revascularization incomplete. He was discharged from the hospital 11 days after the cardiac arrest. AEDs recently have been placed on board some flights by domestic carriers and are likely to become standard on several airlines in the near future. With the improvement of medical equipment on aircraft and superior reporting of medical emergencies, we will better understand the scope of this problem and the benefit of enhanced medical capabilities.