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Resuscitation. 2018 Jun;127:58-62. doi: 10.1016/j.resuscitation.2018.03.024. Epub 2018 Mar 14.

Out-of-hospital cardiac arrest survival in international airports.

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Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland. Electronic address:
Department of Emergency Medicine, School of Medicine, Emory University, Atlanta, GA 30303, USA.
JE Cairnes School of Business and Economics, National University of Ireland, Galway, H91 WN80, Ireland.
Faculty of Engineering and Health Management (ILIS), University of Lille Law and Health, Lille, France.
On Behalf of the Scottish Ambulance Service, NMAHP Research Unit, Unit 13 Scion House, Stirling University, Scotland FK9 4NF.
On Behalf of the Out-of-Hospital Cardiac Arrest Outcomes (OHCAO) Trial, WMS - Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, United Kingdom.
Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
On Behalf of the Queensland Ambulance Service, GPO Box 1425, Brisbane, Qld 4001, Australia.
On Behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR) Steering Group, National University of Ireland Galway, c/o Department of Public Health Medicine, HSE, Letterkenny, Co. Donegal, F92 XK84, Ireland.
Ambulance Victoria Centre for Research and Evaluation, PO Box 2000, Doncaster, Victoria 3108, Australia.
Akureyri Hospital, Eyrarlandsvegur, 600 Akureyri, Iceland.
School of Health, Care and Social Welfare, Mälarden University, Box 883, 721 23 Västerås, Sweden.
Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland.



The highest achievable survival rate following out-of-hospital cardiac arrest is unknown. Data from airports serving international destinations (international airports) provide the opportunity to evaluate the success of pre-hospital resuscitation in a relatively controlled but real-life environment.


This retrospective cohort study included all cases of out-of-hospital cardiac arrest at international airports with resuscitation attempted between January 1st, 2013 and December 31st, 2015. Crude incidence, patient, event characteristics and survival to hospital discharge/survival to 30 days (survival) were calculated. Mixed effect logistic regression analyses were performed to identify predictors of survival. Variability in survival between airports/countries was quantified using the median odds ratio.


There were 800 cases identified, with an average of 40 per airport. Incidence was 0.024/100,000 passengers per year. Percentage survival for all patients was 32%, and 58% for patients with an initial shockable heart rhythm. In adjusted analyses, initial shockable heart rhythm was the strongest predictor of survival (odds ratio, 36.7; 95% confidence interval [CI], 15.5-87.0). In the bystander-witnessed subgroup, delivery of a defibrillation shock by a bystander was a strong predictor of survival (odds ratio 4.8; 95% CI, 3.0-7.8). Grouping of cases was significant at country level and survival varied between countries.


In international airports, 32% of patients survived an out-of-hospital cardiac arrest, substantially more than in the general population. Our analysis suggested similarity between airports within countries, but differences between countries. Systematic data collection and reporting are essential to ensure international airports continually maximise activities to increase survival.


International epidemiology; Out-of-hospital cardiac arrest; Resuscitation; survival

[Indexed for MEDLINE]

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