The incidence of pacemaker dysfunction during helicopter air medical transport

A number of recent publications have raised concern regarding in-flight pacemaker dysfunction during air medical transport. Unfortunately the clinical importance of this problem is unknown. The authors' purpose was to examine the incidence of pacemaker use and malfunction during helicopter air medical transport, using an incidence (cohort) study of an air medical service of a tertiary-care teaching hospital. During the study period, April 1, 1987 through December 31, 1991 2,388 patients were air-transported. Cardiac patients constituted 72% of the total population. Pacemakers were used in 44 patients, temporary transvenous pacemakers in 35, permanent transvenous in five, and transcutaneous pacers in four patients. No rate-responsive pacemakers were transported. No episodes of pacemaker malfunction were observed (95% confidence interval 0 to .002 for the population as a whole). The authors conclude that pacemaker dysfunction during air medical transport is a very rare occurrence, in part due to the infrequent transport of patients requiring these devices.