Out-of-Hospital Cardiac Arrest in US Airports

Area of Science:

• Emergency medicine
• Public health
• Cardiology

Background:

• Airports offer unique advantages for the out-of-hospital cardiac arrest (OHCA) chain of survival, including witnessed events and readily available automated external defibrillators (AEDs).
• Previous analyses suggest higher rates of witnessed OHCA and AED use in airports, but national data for comparison are lacking.

Purpose of the Study:

• To compare out-of-hospital cardiac arrests (OHCAs) occurring in US airports with those in nonairport, nonresidential settings.
• To identify differences in OHCA response characteristics and outcomes between airport and nonairport environments.

Main Methods:

• A cross-sectional study utilizing the National Emergency Medical Services Information System (NEMSIS) database from January 2022 to December 2023.
• Comparison of key cardiac arrest variables, including witnessed status, pre-arrival cardiopulmonary resuscitation (CPR) and AED use, shockable rhythms, and etiology, between airport and nonairport settings.

Main Results:

• The study analyzed 1194 OHCAs in airports and 312,306 in nonairport, nonresidential settings.
• Airports showed significantly higher rates of witnessed arrests (81.0% vs 43.3%), CPR use (62.6% vs 47.8%), AED use (56.3% vs 32.0%), shockable rhythms (28.6% vs 13.8%), and return of spontaneous circulation (40.7% vs 23.8%).
• OHCAs in airports were also associated with a higher prevalence of nontraumatic etiologies (96.1% vs 89.5%).

Conclusions:

• Airports are associated with substantially improved OHCA response and survival outcomes compared to other nonresidential settings.
• Strategies to translate the successful elements of the OHCA chain of survival observed in airports to other public venues are warranted.
• Findings underscore the potential for public spaces to enhance emergency cardiac care response and outcomes.