Experts Call for AED Placement on Every Commercial Aircraft to Boost In-Flight Cardiac Arrest Survival Rates from 6% to Up to 70%

In-flight cardiac arrest is extremely rare, yet catastrophic, and responsible for up to 86% of all deaths in the air. A new comprehensive literature review highlights systemic and policy shortcomings of current aviation safety standards, calling for global alignment. Recommendations include regulated and mandated automated external defibrillators (AEDs) on board, standardized cardiopulmonary resuscitation (CPR) protocols training, and integration of telemedicine. The article in the Canadian Journal of Cardiology, published by Elsevier, aims to inform policy regulators, airlines, and international aviation bodies to improve in-flight medical emergency preparedness and response protocols.

In-flight medical emergencies are an expected challenge, given the global air travel passenger volume of nearly four billion passengers annually. The most prominent risk factors for in-flight cardiac arrest include male sex, age, pre-existing cardiac disease, and duration of flight time. With an aging global passenger population and increasing flight durations due to advancing aircraft technology, the risk and frequency of in-flight cardiac arrest are expected to rise.

“Improving survival rates following a flight passenger’s cardiac arrest hinges on several critical considerations,” states senior author Adrian Baranchuk, MD, Queens University, Canada. “The cabin environment poses a unique challenge, including the confined space of the fuselage, limitations to equipment accessibility, and inconsistent crew CPR and AED training. Currently, only the US legally mandates defibrillators on commercial flights, whereas Canada only federally recommends it and leaves it to the discretion of the airline itself to include them.”

Prompt defibrillation is crucial

AED utilization has a significant impact on survival outcomes in multiple environments. The likelihood of survival for shockable sudden cardiac arrest decreases by 7–10% per minute without defibrillation. Due to the narrow intervention window, diverting a plane for an emergency landing is often unattainable, as it often takes longer than 20 minutes from cruising altitude to a safe landing.

The disparities in AED implementation may hinder swift emergency responses. Without an onboard AED, only approximately 6% of in-flight cardiac arrest patients survive to hospital. Further projections suggest that equipping all commercial aircraft with AEDs could save 35–93 lives annually worldwide.

First author Mario D. Bassi, MD, University of Ottawa, Canada, points out, “Currently, the data show that AEDs are consistently reliable, sensitive to detecting and treating in-flight cardiac arrest, and cost-effective to airlines. AEDs are proven to be safe, with no evidence of detriment or reduced functionality emerging in the compromised environment of the aircraft cabin, such as turbulence. While prompt recognition of a cardiac arrest and CPR initiation are vital, the chances of survival jump from 6% to up to 70% when an AED is used. However, up to one third of EU aircraft were found to not have an AED available in-flight.”

Based on their comprehensive review of the existing literature, the authors recommend:

• Universal implementation of easily accessible onboard AEDs to reduce time to defibrillation

• Standardized airline-specific CPR training for crew

• Integration of telemedicine for real-time guidance and triage (e.g., CPR coaching)

“The primary determinant impacting sudden cardiac arrest survival is the time to defibrillation,” concludes Dr. Baranchuk. “We believe our recommendations and appropriate measures must be strongly considered by policymakers and airlines alike to improve passenger safety and survival rates.”

Notes for editors

The article is “Is There a Doctor on Board?: In-Flight Sudden Cardiac Arrest and Automated External Defibrillator Use,” by Mario D. Bassi, MD, Matthew Kuchtaruk, MD, Nathan Jiang, Cameron Sartor, MD, Shania Sheth, and Adrian Baranchuk, MD, FACC, FRCPC, FCCS, FSIAC (https://doi.org/10.1016/j.cjca.2025.10.010). The article appears online ahead of volume 41, issue 12 (December 2025) of the Canadian Journal of Cardiology, published by Elsevier.

The article is openly available at https://onlinecjc.ca/article/S0828-282X(25)01212-7/fulltext.

Full text of the article is also available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474 or [email protected] to request a PDF of the article or more information. Journalists wishing to interview the authors should contact Dr. Adrian Baranchuk at [email protected] or Dr. Mario D. Bassi at [email protected].

This paper was conceived during the production of the BELTRAN (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators) series of studies, which focuses on the challenges of recognizing and treating out-of-hospital cardiac arrest in unique circumstances, such as stadiums. While working on this project on a flight, Dr. Bassi wondered what would happen in the scenario of cardiac arrest while on a commercial airline. This led to this current review, with the goal of highlighting gaps in in-flight cardiac arrest response to improve patient outcomes globally.

The BELTRAN series of studies was eponymously named after Dr. Jorge Bombau’s young son, Beltran, who sadly passed away after undergoing sudden cardiac arrest while running during a class at school. The authors would like to dedicate this paper to Beltran, Dr. Bombau, and their family.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology (CJC) is an international, peer-reviewed journal that disseminates new knowledge in cardiology and cardiovascular science. It is the preferred Canadian cardiovascular medicine peer-reviewed publication and is an official journal of the Canadian Cardiovascular Society(CCS). The CJC publishes original reports of clinical and basic research relevant to cardiovascular medicine, as well as practice guidelines, editorials, review articles, and case reports. www.onlinecjc.ca

About the Editor-in-Chief

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit www.ccs.ca/en.

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