Key Points
Question How are out-of-hospital cardiac arrest (OHCA) cases at US airports different from OHCA cases at other public venues?
Findings This cross-sectional study used a nationwide database of emergency medical services (EMS) activations in the US to compare OHCA in airports with nonairport nonresidential settings. Airports were associated with significantly increased rates of witnessed cardiac arrests, cardiopulmonary resuscitation and automated external defibrillator use before EMS arrival, shockable rhythms, and return of spontaneous circulation.
Meaning This study suggests that, due to a variety of factors, airports are associated with improved OHCA response and survival outcomes compared with other nonresidential settings—other public venues should try to replicate these factors to improve their cardiac arrest preparedness.
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 < .001), witnessed cardiac arrests (81.0% [967 of 1194] vs 43.3% [135 091 of 312 306]; P < .001), CPR before EMS arrival (62.6% [742 of 1194] vs 47.8% [149 166 of 312 306]; P < .001), AED use before EMS arrival (56.3% [672 of 1194] vs 32.0% [100 020 of 312 306]; P < .001), shockable rhythms (28.6% [341 of 1194] vs 13.8% [43 187 of 312 306]; P < .001), and return of spontaneous circulation (40.7% [486 of 1194] vs 23.8% [74 467 of 312 306]; P < .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.
