In-Flight Evaluation and Management of Cardiac Illness

Abstract

Cardiac diseases represent the most frequent in-flight emergencies (almost 50% of cases) and the overwhelming majority of diversions. In-flight cardiac arrest is fortunately quite rare (0.3% of in-flight emergencies) but is responsible for 86% of in-flight events resulting in death. The introduction of automated external defibrillators (AED) on-board definitely changed the management of this condition. Diversion should be promptly considered if CPR is attempted. Acute coronary syndromes are a medical challenge without the help of the ECG nor biomarkers. In cases of likely acute coronary syndrome in an ill-appearing patient or in patients presenting with unstable features (deranged vital signs/clinical signs of cardiac failure), the captain should be advised to divert immediately. Syncope and pre-syncope are the most frequent condition occurring aboard commercial flights. The challenge is to made the distinction between vagal faintness and true intravascular volume depletion. In the case of rapid resolution of symptoms in a previously health person, it is reasonable to advise against diversion. Conversely, persistent symptoms, significant pre-existing conditions, or the presence of cardiac risk factors plead for diversion. Correctly diagnosing acute decompensated heart failure is a clinical challenge for physicians regardless of setting. The principal measure to set up urgently is the administration of supplemental oxygen. Diversion for ground based rescue should be advised in most suspected cases of decompensated heart failure as therapeutic options on-board are very limited.