Internal and Emergency Medicine

, Volume 13, Issue 8, pp 1305–1322 | Cite as

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM)

  • Jochen HinkelbeinEmail author
  • Lennert Böhm
  • Stefan Braunecker
  • Harald V. Genzwürker
  • Steffen Kalina
  • Fabrizio Cirillo
  • Matthieu Komorowski
  • Andreas Hohn
  • Jörg Siedenburg
  • Michael Bernhard
  • Ilse Janicke
  • Christoph Adler
  • Stefanie Jansen
  • Eckard Glaser
  • Pawel Krawczyk
  • Mirko Miesen
  • Janusz Andres
  • Edoardo De Robertis
  • Christopher Neuhaus


By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.


CPR Cardiopulmonary resuscitation Cardiac arrest Airplane In-flight medical emergencies BLS AED 



The manuscript was prepared by the working group “guidelines, recommendations, and statements” of the German Society of Aerospace Medicine and reviewed by the board of the German Society of Aerospace Medicine (DGLRM). The authors thank Prof. Douglas Boyd (University of Texas) sincerely for his critical comments, language editing, and improving the quality of this manuscript.

Compliance with ethical standards

Conflict of interest

C.N. is the Treasurer of the German Society for Aviation and Space Medicine (DGLRM). E.D.R. received honorarium from MSD. E.G. is the CEO of the German Academy for Aviation and Travel Medicine (DAFR). H.G. received travel reimbursement for presentations from Ambu and VBM, Germany. J.H. is the President of the German Society for Aviation and Space Medicine (DGLRM) and Treasurer of the European Society of Aerospace Medicine (ESAM) as well as Chairman of the ESAM Space Medicine Group; J.S. is employed at Lufthansa. C.A., A.H., M.B., S.J., J.A., P.K., F.C., I.J., and M.K. have no conflicts of interest.

Statements of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this study, formal consent was not required


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Copyright information

© SIMI 2018

Authors and Affiliations

  • Jochen Hinkelbein
    • 1
    • 2
    • 3
    Email author
  • Lennert Böhm
    • 9
  • Stefan Braunecker
    • 1
    • 2
    • 4
  • Harald V. Genzwürker
    • 5
  • Steffen Kalina
    • 2
    • 3
  • Fabrizio Cirillo
    • 3
    • 6
  • Matthieu Komorowski
    • 7
  • Andreas Hohn
    • 3
  • Jörg Siedenburg
    • 8
  • Michael Bernhard
    • 9
  • Ilse Janicke
    • 2
    • 10
  • Christoph Adler
    • 11
  • Stefanie Jansen
    • 12
  • Eckard Glaser
    • 1
    • 2
    • 13
  • Pawel Krawczyk
    • 14
  • Mirko Miesen
    • 15
  • Janusz Andres
    • 14
  • Edoardo De Robertis
    • 6
  • Christopher Neuhaus
    • 1
    • 2
    • 16
  1. 1.Working group “guidelines, recommendations, and statements”German Society of Aviation and Space MedicineMunichGermany
  2. 2.Working group “emergency medicine and air rescue”German Society of Aviation and Space MedicineMunichGermany
  3. 3.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital CologneCologneGermany
  4. 4.Department of Critical CareKing’s College HospitalLondonUK
  5. 5.Department of AnaesthesiologyNeckar-Odenwald-KlinikenMosbachGermany
  6. 6.Department of Neurosciences, Reproductive and Odontostomatological SciencesUniversity of Naples “Federico II”NaplesItaly
  7. 7.Department of Surgery and Cancer, Faculty of MedicineImperial College LondonLondonUK
  8. 8.UetersenGermany
  9. 9.Emergency DepartmentUniversity of DuesseldorfDüsseldorfGermany
  10. 10.Department for Cardiology and Angiology, Heart Center DuisburgEvangelisches Klinikum NiederrheinDuisburgGermany
  11. 11.Department of Internal Medicine IIIHeart Center of the University of CologneCologneGermany
  12. 12.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of CologneCologneGermany
  13. 13.GerbrunnGermany
  14. 14.Department of Anaesthesiology and Intensive Care MedicineJagiellonian University Medical CollegeCracowPoland
  15. 15.YourCockpit Flight SimulatorCologneGermany
  16. 16.Department of AnaesthesiologyUniversity Hospital HeidelbergHeidelbergGermany

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