The n e w e ng l a n d j o u r na l of m e dic i n e

TEACHING points

Presentation, Diagnosis, and Treatment of Cardiac Arrest

during Air Flight
• Health care professionals are often asked to assist passengers with medical
issues on commercial airline flights. However, most health care professionals
are unfamiliar with the available resources and protocols.

• The Federal Aviation Administration determines the requirements for the

contents of medical kits on U.S. airlines. Many kits contain medications and
equipment beyond the minimum requirements.

• The assessment of an airline passenger with chest pain should focus on the
likelihood of a serious cardiac, pulmonary, or vascular event. Ground-based
medical support should be contacted for further recommendations and
discussion of aircraft diversion.

• In a passenger with suspected acute myocardial infarction, medical management

should be conducted in accordance with standard guidelines and the use of the
medications available in the medical kit. Since the resources in the kit may be
limited, the potential risks and benefits of the administration of any medication
should be carefully considered.

• Standard protocols for cardiopulmonary resuscitation should be followed

when managing the care of a passenger in cardiac arrest.

These teaching points are drawn from the Interactive Medical Case. For more information, see
Loewenthal JV, Vaidya A, Duran B, Pozner CN, Scirica BM. Up in the Air. N Engl J Med
2022;386:e7.