Letter To The Editor
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2020; 12(3): 107-109
Published online Mar 26, 2020. doi: 10.4330/wjc.v12.i3.107
Demystifying airline syncope
Thomas Kingsley, Robert Kirchoff, James S Newman, Rahul Chaudhary
Thomas Kingsley, Robert Kirchoff, James S Newman, Rahul Chaudhary, Division of Hospital Internal Medicine, Department of Internal Medicine, Hospital Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Rahul Chaudhary, Indiana University Purdue University Indianapolis, Indianapolis, IA 46202, United States
Author contributions: All authors contributed to this paper; Kingsley T and Kirchoff R contributed equally to the manuscript.
Conflict-of-interest statement: All authors report no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rahul Chaudhary, MD, FACP, Associate Consultant – Clinical, Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. chaudhary.rahul@mayo.edu
Received: November 12, 2019
Peer-review started: November 12, 2019
First decision: December 11, 2019
Revised: January 6, 2020
Accepted: February 17, 2020
Article in press: February 17, 2020
Published online: March 26, 2020
Processing time: 132 Days and 8.3 Hours
Abstract

Syncope forms a major part of medical in-flight emergencies contributing one-in-four in-flight medical events accounting to 70% of flight diversions. In such patients, it is important to elucidate the pathophysiology of syncope prior to diversion. Postural hypotension is the most common etiology of in-flight syncopal events. However, individuals without any underlying autonomic dysfunction can still experience syncope from hypoxia also known as airline syncope. Initial steps in managing such patients include positioning followed by the airway, breathing and circulation of resuscitation. These interventions need to be in close coordination with ground control to determine decision for flight diversion. Interventions which have been tried for prevention include mental challenge and increased salt and fluid intake. The current paper enhances the understanding of airline syncope by summarizing the associated pathophysiologic mechanisms and the management medical personnel can initiate with limited resources.

Keywords: Syncope; Airline syncope; Aviation; Pathophysiology; Hypoxic syncope; In-flight emergency

Core tip: Airline syncope is a major cause of in-flight emergencies. Understanding the pathophysiologic mechanism behind the event is a key in stabilizing the patient and determining if flight diversion is required.