Aviation Cardiology: Occupational Hazards and Cardiac Surgery Facts for Aircrew and Passengers Undergoing Cardiac Surgery Are Discussed

T. Syburra; R. vonWattenwyl; D. Bron; E. Nicol

Disclosures

Eur Heart J. 2019;40(25):1998-2000. 

In This Article

Passengers

Passenger's health state has significant influence on flight safety and operations, albeit less safety critical than for aircrew. Passengers must be able to evacuate aircraft in (the legally prescribed time) of 90s and should not be emplaned if they risk becoming a hazard that is likely to cause the plane to make an emergency landing. Emergency landings induce additional operational risks that should not to be underestimated (unbriefed airport, lack of specific crew training, weather conditions, considerable costs, and delays). Airlines publish their individual regulations regarding the conditions for emplaning post-operative patients.

The International Air Transport Association (IATA) (Table 1), International Civil Aviation Organization (ICAO), and the World Health Organization (WHO) regulate the global legal framework.

As a passenger after heart surgery, it is generally safe to fly from the 14th post-operative day. Six weeks after heart surgery, almost every patient should comply with the vast majority of the airlines' rules. If a flight is required earlier than the 14th post-operative day, the cardiac surgeon is advised to contact the airline's specific medical service. Early post-operative patients are considered by the European Aviation Safety Agency (EASA) as a Special Category of Passengers (SCP) and EASA publishes regular updates on the requirements about the provisions for the carriage of SCP's and defines their impact on flight safety in their document EASA.2008.C.25. Attending physicians will also find detailed instructions published by the Aerospace Medical Association, particularly in their 2nd edition of the 'Medical Guidelines for Airline Travel'.[4]

As an example, from the 10th post-operative day after aorto-coronary bypass surgery or valve surgery, most patients would be fit to fly, provided they had an uncomplicated post-operative recovery. Residual trapped air in the thorax pneumothorax (following median sternotomy or thoracotomy) expands at altitude and is associated with a risk of barotrauma. At usual cruising altitude, the cabin pressure usually corresponds to an altitude of 6–8000 feet, where the trapped gas expands by 25–30%. This period corresponds to the physiological resorption time of trapped thoracic gas. The patient should have been clinically evaluated by his attending physician before the flight in order to rule out any signs of heart failure, arrhythmia, residual ischaemia, or pneumothorax.

After percutaneous coronary intervention, the minimum waiting period is 3 days.

Finally, it should be noted that many airlines require a completed 'Medical Clearance Form' until the 21st day after intervention. If any doubt exists, or if the passenger needs to fly earlier, the surgeon should always contact the airline's medical service for specific advice.

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