CPR and AED Training: Is it Working?

1. 27th International Aircraft Cabin Safety Symposium CPR and AED Training:Is it Working? Paulo M. Alves, MDMedaire

2. The Challenge Some People die fly fly & die

3. The Reality .05 deaths Per billion RPKs 1 death Per every 7M pax 4.8 deaths Per month Source: MedLink Global Response Center

4. The Stress Onboard cardiac arrests & deaths extremely stressful situations for cabin crew and passengers

5. Why?Factors involved Time Length of the flight Individual Pre-existing conditions EnvironmentAltitude

6. Who?

7. 3 Possibilities Passenger has: Severe medical condition that is unknown 1 Severe/terminal medical condition and is travelling to die in home country Severe medical condition and is travelling to better level of care 2 3

8. The IndividualPre-existent Conditions

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

10. Some people fly… (try to die) but don’t die! The Advent of AEDs

11. 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...

12. AED Timeline 2001FAA – Appendix A – Part 121 - AEDs required by April 2004 1990Virgin Atlantic – Public Access Defibrillation (AHA-ERC-ILCOR) 2005 New Guidelines from AHA 1996American Airlines 1986British Caledonian (Chapman and Chamberlain) 2010 Virtually all major international airlines carrying AEDs 1991Qantas

13. Is it Working?

14. 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 Chicago Airports’ Experience 48%OverallSurvivalRate 56%Survival rate from VF Caffrey et al N Engl J Med 2002; 347:1242-7

15. Qantas’ Experience 22% 23% 33% O’Rourke et al - Circulation 1997

16. American Airlines’ Experience Note: 46 (82% long-term saves)

17. MedAire’s MedLink® In-Flight Experience

18. How Can We Improve?

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

20. An Airline Challenge:Witnessed vs. Unwitnessed Collapse

21. Who Operated the AED?

22. Remarks on CPR Performance • 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

23. Example1. CPR in progress while AED being connected Too long a pause for breathing…

24. Example 2. Short breathing pause CPR – 30 compressions Overall frequency: 140 cpm

25. Example 3. Shock promptly delivered 15 compressions cycle CPR promptly resumed after shock Short breathing pause

26. CPR compressions over VF Conversion of VF after shock CPR promptly resumed after shock

27. 30 Minutes later… It’s a Save!!!!!

28. Conclusions • Congratulations—it’s working! • Survival-to-hospital rates of 25% are impressive • Training focused on AHA recommendations • Less interruptions • High level of awareness

29. Questions? Hercules Fighting Death to Save Alcestis by Frederic Lord Leighton slightly modified by PM Alves