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This is a Cross-Sectional study.

September 5, 2025JAMA Network Open1 citationsOpen Access

Out-of-Hospital Cardiac Arrest in US Airports

ASAditya C. ShekharIcahn School of Medicine at Mount Sinai JKJoshua KimbrellAlbert Einstein College of Medicine TFTimothy FriedmannMount Sinai Hospital

Key Points

Airports are linked to higher rates of witnessed cardiac arrests, showing 81.0% versus 43.3% in nonairport settings.
Use of automated external defibrillators (AEDs) before EMS arrival was more common at airports, with 56.3% compared to 32.0% elsewhere.
The study analyzed data from the National Emergency Medical Services Information System and included OHCAs from 2022 to 2023.
Findings indicate a need to adopt successful airport strategies for improving out-of-hospital cardiac arrest survival in other venues.

Abstract

Importance Airports are uniquely situated to facilitate several aspects of the out-of-hospital cardiac arrest (OHCA) chain of survival, including a high likelihood of cardiac arrest events being witnessed and the ready availability of automated external defibrillators (AEDs). Focused analyses suggest airports are associated with a higher prevalence of witnessed cardiac arrest and AED use; however, there is a lack of national US data on the topic to facilitate comparison of response characteristics with other OHCA events occurring in nonairport locations. Objective To compare OHCAs occurring at airports with OHCAs occurring in nonairport, nonresidential settings. Design, Setting, and Participants This cross-sectional study used a national-level database of emergency medical services (EMS) activations in the US, the National Emergency Medical Services Information System. Inclusion criteria were any adult (≥18 years) experiencing cardiac arrest prior to EMS arrival between January 1, 2022, and December 31, 2023. Main Outcomes and Measures Key cardiac arrest variables (witnessed status, pre-EMS cardiopulmonary resuscitation CPR or AED use, shockable rhythms, and etiology) were compared across cardiac arrests in airports and nonairport, nonresidential settings. Results A total of 1194 OHCAs in airport settings (452 among individuals aged 18-60 years 37.9%; 867 among men 72.6%) and 312 306 OHCAs in nonairport, nonresidential settings (147 431 among individuals aged 18-60 years 47.2%; 211 364 among men 67.7%) met inclusion criteria. Airports were associated with significantly higher rates of nontraumatic etiologies (96.1% 1148 of 1194 vs 89.5% 279 462 of 312 306; P lt; .001), witnessed cardiac arrests (81.0% 967 of 1194 vs 43.3% 135 091 of 312 306; P lt; .001), CPR before EMS arrival (62.6% 742 of 1194 vs 47.8% 149 166 of 312 306; P lt; .001), AED use before EMS arrival (56.3% 672 of 1194 vs 32.0% 100 020 of 312 306; P lt; .001), shockable rhythms (28.6% 341 of 1194 vs 13.8% 43 187 of 312 306; P lt; .001), and return of spontaneous circulation (40.7% 486 of 1194 vs 23.8% 74 467 of 312 306; P lt; .001) compared with nonairport, nonresidential settings. Conclusion and Relevance This study suggest that airports are associated with substantially improved OHCA response and survival outcomes compared with other nonresidential settings. Further efforts are needed to establish strategies to translate the relevant parts of the chain of OHCA survival found at airports to other public venues.

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