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Safety of aeromedical repatriation after myocardial infarction: a retrospective study
  1. M D Thomas1,
  2. R Hinds2,
  3. C Walker2,
  4. F Morgan2,
  5. P Mason2,
  6. D Hildick-Smith1
  1. 1Sussex Cardiac Centre, The Royal Sussex County Hospital, Eastern Road, Brighton, UK
  2. 2Healix International Ltd, Hampton, UK
  1. Correspondence to:
    Dr Martin Thomas
    Sussex Cardiac Centre, The Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK; thomasmd{at}

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UK residents make over 64 million visits abroad each year, with European Union countries accounting for 70% of destinations.1 Unfortunately taking a holiday is associated with an increased risk of having a myocardial infarction.2 Current guidelines recommend a delay of up to 21 days after uncomplicated myocardial infarction before commercial air travel.3

The main concern for transportation of cardiac patients is the effect of hypoxia at altitude. Aircraft are pressurised to achieve cruising altitude cabin pressures equivalent to 2440 m above sea level and at these pressures oxygen tension decreases 60% to a PaO2 of 55 mm Hg, which results in a haemoglobin saturation of about 90% in patients with normal cardiorespiratory function.4 This presents no problem for healthy people but may be detrimental to patients with cardiac ischaemia. Hypoxia results in tachycardia with increased cardiac output and subsequent decrease in ischaemic threshold.5 Cardiac ischaemia may also be aggravated by raised catecholamines caused by patient anxiety. Transportation of a patient with a recent acute coronary syndrome in a hypoxic environment is therefore potentially hazardous.

Two small studies have examined the safety of …

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