CPR and AED Training:

Is it Working?Paulo M. Alves, MD

Medaire

27th International Aircraft Cabin Safety Symposium

The Challenge

Peopleflydie

Some

fly & die

The Reality

1 deathPer every 7M pax

.05 deathsPer billion RPKs

4.8 deathsPer month

Source: MedLink Global Response Center

The Stress

Onboard cardiac arrests & deaths

extremely stressful situations for cabin crew and passengers

IndividualPre-existing conditions

EnvironmentAltitude

TimeLength of the flight

Why?Factors involved

Who?

Severe medical condition that is unknown

3 Possibilities

Passenger has:

1

2

3

Severe medical condition and is travelling to better level of care

Severe/terminal medical condition and is travelling to die in home country

The IndividualPre-existent Conditions

Male 62 years old (SD = 16.7) No reported pre-existent condition Departing from LHR Going to LHR HKG-LHR (5 cases only)

The Typical Candidate

Some people fly… (try to die)

but don’t die!

The Advent of AEDs

A Brief Review Ventricular fibrillation (VF)

◦ 70% out-of-hospital Sudden Cardiac Arrests - Typical for MI◦ Importance of witnessed vs. un-witnessed collapse

Pulseless electrical activity (PEA)◦ Trauma, pulmonary embolism, massive MI, etc

Asystole◦ Hypoxia◦ Common final pathway (both VF and PEA evolves to

asystole) The only chance to resuscitate someone is

to remove the causing factor!! CPR keeps life only...

1986 British Caledonian

(Chapman and Chamberlain)

2001 FAA – Appendix A – Part 121

- AEDs required by April 2004

2005 New Guidelines from

AHA

1991 Qantas

2010Virtually all

major international

airlines carrying AEDs

1990 Virgin Atlantic –

Public Access Defibrillation (AHA-ERC-

ILCOR)1996

American Airlines

AED Timeline

Is it Working?

Chicago Airports’ Experience

48%OverallSurvivalRate

56%Survival rate from VF

Caffrey et al N Engl J Med 2002; 347:1242-7

26 uses + 4

4 cases no-SCA 21 cases19 male / 2 fem 1 case trauma

20 witnessed

2 PEA 18 VF

11 ROSC 10 alive after 1 year 7 deaths

Qantas’ Experience

2 su rviva ls

6 V F

2 7 A E D1 6 w itn s .

5 4 M on ito r

8 1In flig h t

4 su rviva ls

1 7 V F

1 9 A E D1 7 w itn s

9 M on ito r

2 8Term in a ls

1 0 9 casos6 5 m on th s

O’Rourke et al - Circulation 1997

33%

22%

23%

American Airlines’ Experience

Note: 46 (82% long-term saves)

AllUtilizations

947 cases

Monitoring only609 (64.3%)

AED338 (35.7%)

No Shock Advised

256 (75.7%)

Shock Advised (VF)

82 (24.3%)Survival to

Hospital

21 -23 (25.6%-28.0%)

MedAire’s MedLink® In-Flight Experience

How Can We Improve?

VF vs. Non-VF in Long-Haul Distribution Along the Flight

An Airline Challenge:

Witnessed vs. Unwitnessed Collapse

Who Operated the AED?

A large proportion of sequences were of only 5 to 8 compressions

Cycles of 5-47 compressions Most common cycle = 5 compressions Very long pauses for ventilation observed Compressions given above 120 per minute Low number of compressions in a minute

Remarks on CPR Performance

Example1.

CPR in progress while

AED being connected

Too long a pause for

breathing…

Example 2.

CPR – 30 compressions

Short breathing

pause

Overall frequency: 140

cpm

Example 3.

Shock promptly delivered CPR promptly

resumed after shock

Short breathing

pause

15 compressions

cycle

CPR compressions

over VF

Conversion of VF after shock

CPR promptly resumed after

shock

30 Minutes later…

It’s a Save!!!

!!

Congratulations—it’s working!◦ Survival-to-hospital rates of 25% are

impressive Training focused on AHA

recommendations◦ Less interruptions

High level of awareness

Conclusions

Questions?

Hercules Fighting Death to Save Alcestis by Frederic Lord Leighton slightly modified by PM Alves