Experts Urge AEDs on Aircraft to Improve Survival Rates in Cardiac Emergencies

A comprehensive review published in the Canadian Journal of Cardiology advocates for the mandatory placement of automated external defibrillators (AEDs) on all commercial aircraft. This recommendation arises from the alarming fact that in-flight cardiac arrest, while rare, accounts for up to 86% of fatalities during flights. The authors highlight critical gaps in current aviation safety standards and call for global regulatory alignment to enhance in-flight medical emergency preparedness.

The review, led by senior author Adrian Baranchuk, MD, from Queens University in Canada, emphasizes the urgent need for standardized training in cardiopulmonary resuscitation (CPR) and the integration of telemedicine solutions. With nearly four billion passengers flying annually, the potential for in-flight medical emergencies is significant.

The study identifies key risk factors for in-flight cardiac arrest, including male gender, advanced age, pre-existing cardiac conditions, and longer flight durations. As more passengers age and flights become longer due to advancements in aircraft technology, the likelihood of such emergencies is predicted to increase.

Dr. Baranchuk underscores the unique challenges posed by the aircraft environment. “The confined space of the fuselage and varied levels of crew training in CPR and AED use complicate timely medical interventions,” he states. Currently, only the United States mandates AEDs on commercial flights, while Canada merely recommends their presence, leaving it to airlines to decide.

Research indicates that prompt defibrillation significantly influences survival outcomes. The chance of survival for patients experiencing a shockable sudden cardiac arrest diminishes by 7% to 10% per minute without intervention. Given that diverting a plane for an emergency landing often takes longer than 20 minutes, the absence of an onboard AED severely hampers effective response.

Statistics reveal that without an AED, survival rates drop to approximately 6% for passengers experiencing cardiac arrest during flights. The authors project that equipping all commercial aircraft with AEDs could save between 35 and 93 lives each year worldwide.

First author Mario D. Bassi, MD, from the University of Ottawa, points out that “AEDs are reliable and sensitive in detecting and treating in-flight cardiac arrest. They are also cost-effective for airlines.” The safety of AEDs has been established, with no evidence suggesting they malfunction in the challenging conditions of an aircraft cabin, including during turbulence.

Dr. Bassi notes that while immediate recognition of a cardiac arrest and the initiation of CPR are essential, the survival odds increase dramatically—from 6% to as high as 70%—when an AED is utilized. Alarmingly, it was found that up to one-third of aircraft in the European Union do not have AEDs onboard.

The authors conclude their review with a strong call to action. “The primary determinant impacting sudden cardiac arrest survival is the time to defibrillation,” asserts Dr. Baranchuk. He stresses that their recommendations should be prioritized by policymakers and airlines to enhance passenger safety.

For further details, refer to the article: “Is There a Doctor on Board?: In-Flight Sudden Cardiac Arrest and Automated External Defibrillator Use,” published in the Canadian Journal of Cardiology in 2025. The DOI for the study is 10.1016/j.cjca.2025.10.010.