cpr and aed training: is it working?
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27 th International Aircraft Cabin Safety Symposium. CPR and AED Training: Is it Working?. Paulo M. Alves, MD Medaire. The Challenge. Some. People. die. fly. fly & die. The Reality. .05 deaths Per billion RPKs. 1 death Per every 7M pax. 4.8 deaths Per month. - PowerPoint PPT PresentationTRANSCRIPT
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CPR and AED Training:
Is it Working?Paulo M. Alves, MD
Medaire
27th International Aircraft Cabin Safety Symposium
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The Challenge
Peopleflydie
Some
fly & die
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The Reality
1 deathPer every 7M pax
.05 deathsPer billion RPKs
4.8 deathsPer month
Source: MedLink Global Response Center
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The Stress
Onboard cardiac arrests & deaths
extremely stressful situations for cabin crew and passengers
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IndividualPre-existing conditions
EnvironmentAltitude
TimeLength of the flight
Why?Factors involved
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Who?
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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
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The IndividualPre-existent Conditions
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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
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Some people fly… (try to die)
but don’t die!
The Advent of AEDs
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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...
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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
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Is it Working?
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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
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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%
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American Airlines’ Experience
Note: 46 (82% long-term saves)
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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
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How Can We Improve?
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VF vs. Non-VF in Long-Haul Distribution Along the Flight
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An Airline Challenge:
Witnessed vs. Unwitnessed Collapse
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Who Operated the AED?
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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
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Example1.
CPR in progress while
AED being connected
Too long a pause for
breathing…
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Example 2.
CPR – 30 compressions
Short breathing
pause
Overall frequency: 140
cpm
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Example 3.
Shock promptly delivered CPR promptly
resumed after shock
Short breathing
pause
15 compressions
cycle
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CPR compressions
over VF
Conversion of VF after shock
CPR promptly resumed after
shock
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30 Minutes later…
It’s a Save!!!
!!
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Congratulations—it’s working!◦ Survival-to-hospital rates of 25% are
impressive Training focused on AHA
recommendations◦ Less interruptions
High level of awareness
Conclusions
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Questions?
Hercules Fighting Death to Save Alcestis by Frederic Lord Leighton slightly modified by PM Alves