Is There a Doctor on Board?: In-Flight Sudden Cardiac Arrest and Automated External Defibrillator Use

In-flight sudden cardiac arrest (IFCA) is rare yet highly fatal aboard commercial flights, accounting for up to 86% of all in-flight casualties. The most prominent risk factors for IFCA include male sex, age, pre-existing cardiac disease, and duration of flight time. Prompt recognition of IFCA, cardiopulmonary resuscitation, and automated external defibrillator (AED) use are all strongly associated with improved patient outcomes; survival is approximately 6% without an AED present but rises to 21-70% with AED use. Research has confirmed that AEDs are highly sensitive, reliable in turbulent environments, and cost-effective. However, the confined environment of an airline imposes unique challenges in the response to IFCA, such as limited space, delayed access to medical equipment, and delayed diversion times often exceeding the 3-5-minute recommendation for defibrillation. Despite their utility, many countries lack mandated legislation in requiring AEDs on flights, which highlights a fundamental gap in treating IFCA. Crew cardiopulmonary resuscitation proficiency is another cornerstone in IFCA response, yet there is no specific standard for airline-specific CPR training. Live telemedicine in-flight provides physicians and staff the ability to navigate IFCA efficiently and acts as a novel tool that can be used efficaciously. Good Samaritan legal protections reduce liability concerns and encourage intervention yet is not an international standard and has significant regional variability. Recommendations including universal AED placement on commercial flights, standardized airline-specific CPR and AED training, telemedicine integration, and enhanced awareness of legal liability may act to improve passenger survival from IFCA.