University of Pittsburgh Affiliated Residency in Emergency Medicine, Pittsburgh, Pennsylvania 15216, USA.
Prehosp Emerg Care. 2010 Apr-Jun;14(2):235-9. doi: 10.3109/10903120903572319.
Limited information exists about the in-flight use and outcomes associated with automated external defibrillators (AEDs) on commercial airlines.
To describe the characteristics and outcomes of AED use during in-flight emergencies including in-flight cardiac arrest and the associated ground medical consultation patterns.
We collected cases of AED use that were self-reported to an airline consultation service from three U.S. airlines between May 2004 and March 2009. We reviewed all available data files, related consultation forms, and recordings. For each case, demographics, initial rhythm, shock delivery/success, survival to admission, and ground medical consultation use were obtained. Success was defined as the return of a perfusing rhythm. Initial rhythms were classified as sinus, heart block, supraventricular tachycardia (SVT), atrial fibrillation/flutter, asystole, pulseless electrical activity (PEA), and ventricular fibrillation (VF)/ventricular tachycardia (VT).
There were a total of 169 AED applications with 40 cardiac arrests. The mean patient ages were 58 years (standard deviation [SD] 15) and 63 years (SD 12), respectively; both populations were 64% male. AEDs were applied for monitoring in 129 (76%) cases with the following initial rhythms: sinus, 114 (88%); atrial fibrillation/flutter, seven (5%); complete heart block, four (3%); and SVT, four (3%). Presenting rhythms among the cardiac arrest population were as follows: asystole, 16 (40%); VF/VT, 10 (25%); and PEA, 14 (35%). Fourteen patients were defibrillated, including nine of the 10 patients with initial VF/VT and five for the presence of VF/VT after resuscitation for initial PEA/asystole. Defibrillation was advised but not performed in the remaining case of initial VF/VT, and no medical consultation was obtained. All five successful defibrillations occurred in patients with initial VF/VT. There were six (15%; 95% confidence interval [CI] 3-27%) survivors, with five survivals occurring after successful defibrillation for initial VF/VT and one with return of a perfusing rhythm after cardiopulmonary resuscitation (CPR) for a junctional rhythm. Survival in those with VF/VT was five of 10 (50%; 95% CI 14-86%). Medications were delivered in two cases. The median time to first shock was 19 seconds (interquartile range [IQR] 12-24 seconds) after AED application. Medical consultation was obtained in 42 (33%) of the 129 AED monitoring cases and 14 (35%) of the 40 cardiac arrest cases.
Use of AEDs resulted in 50% survival among those with VF/VT in flight and 15% overall survival for cardiac arrest. Survival is poor among patients presenting with nonshockable rhythms. AEDs are used extensively for in-flight monitoring, with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests.
关于商业航班上使用自动体外除颤器（AED）的信息有限，包括使用情况和相关结果。
描述航班紧急情况下使用 AED 的特征和结果，包括航班中心脏骤停和相关地面医疗咨询模式。
我们收集了自 2004 年 5 月至 2009 年 3 月期间，美国三家航空公司向航空公司咨询服务报告的 AED 使用案例。我们审查了所有可用的数据文件、相关咨询表和录音。对于每个案例，我们获得了人口统计学、初始节律、电击输送/成功、存活至入院和地面医疗咨询使用情况。成功定义为恢复可除颤节律。初始节律分为窦性、心脏阻滞、室上性心动过速（SVT）、心房颤动/扑动、心搏停止、无脉电活动（PEA）和心室颤动（VF）/室性心动过速（VT）。
共有 169 次 AED 应用，其中 40 例发生心脏骤停。平均患者年龄分别为 58 岁（标准差 [SD] 15 岁）和 63 岁（SD 12 岁），均为 64%为男性。129 例（76%）因监测使用了 AED，初始节律如下：窦性 114 例（88%）；心房颤动/扑动 7 例（5%）；完全心脏阻滞 4 例（3%）；SVT 4 例（3%）。心脏骤停人群的初始节律如下：心搏停止 16 例（40%）；VF/VT 10 例（25%）；PEA 14 例（35%）。14 例患者进行了除颤，包括 10 例初始 VF/VT 中的 9 例和 5 例初始 PEA/心搏停止复苏后出现 VF/VT。在其余初始 VF/VT 患者中，建议除颤但未实施，也未获得医疗咨询。所有 5 次成功除颤均发生在初始 VF/VT 患者中。有 6 例（15%；95%置信区间 [CI] 3-27%）幸存者，其中 5 例在初始 VF/VT 成功除颤后存活，1 例在结律的心肺复苏（CPR）后恢复可除颤节律存活。VF/VT 患者的存活率为 5/10（50%；95%CI 14-86%）。有两例患者使用了药物。AED 应用后首次电击的中位时间为 19 秒（四分位距 [IQR] 12-24 秒）。在 129 例 AED 监测病例中，有 42 例（33%）和 40 例心脏骤停病例中有 14 例（35%）获得了地面医疗咨询。
在航班中心脏骤停患者中，VF/VT 患者使用 AED 的存活率为 50%，总体存活率为 15%。出现非除颤节律的患者存活率较低。AED 广泛用于航班监测，可识别出显著的节律。在 AED 使用和心脏骤停中，只有三分之一的情况下寻求地面医疗咨询。
