Development of a guideline for CPR in microgravity

Steffen Kerkhoff, Stefan Braunecker, Fabrizio Cirillo, Edoardo De Robertis, Eckard Glaser, Peter Hodkinson, Ivan Zefiro Iovino, Stefanie Jansen, Matthieu Komorowski, Christopher Neuhaus, Lucas REHNBERG, Gianmarco Romano, Thais Russomano, Jan Schmitz, Oliver Spelten, Oliver Ullrich, Tobias Warnecke, Rochelle VELHO, Jochen Hinkelbein

Research output: Contribution to conference typesAbstractpeer-review


Considering future space exploration missions and the arising space tourism with more humans staying for longer periods in space, medical emergencies become more and more likely to happen. So far, no severe medical emergency has happened in space – especially no cardiac arrest. Although evidence-based and proven guidelines for cardiopulmonary resuscitation (CPR) on Earth exist there is no guideline for its application under the special circumstances of spaceflight. In particular, the application of chest compressions on Earth is highly dependent on the presence of gravity and requires a completely different approach in microgravity. But also, the physiological changes and limitations in terms of personnel and material resources in spaceflight pose an unanswered challenge for medical care during such missions.
In the beginning a taskforce was created to develop a guideline for CPR in microgravity, based on the members clinical and scientific background. After a brainstorming phase PICO-questions were developed to guide the systematic literature research. The literature research was then carried out using “MEDLINE”. There were 4,356 abstracts identified in the first place, that were consecutively screened by at least two reviewers using the browser-based tool “abstrackr”. The 265 selected papers were then rated using the GRADE-method. There were 15 subtopics identified for the guideline and for each subsection at least 2 taskforce members proposed recommendations based on the retrieved literature. Afterwards the proposed recommendations were subject to the structured consensus finding process using a two round DELPHI-method.
We recommend a differentiated approach to CPR in microgravity with a division into basic life support (BLS) and advanced life support (ALS) similar to the Earth-based guidelines. In immediate BLS, the chest compression method of choice is the Evetts-Russomano method (ER), whereas in an ALS scenario, with the patient being restrained on the Crew Medical Restraint System, the handstand method (HS) should be applied. Airway management should only be performed if at least two rescuers are present and the patient has been restrained. A supraglottic airway device should be used for airway management where crew members untrained in endotracheal intubation (ETI) are involved.
CPR in microgravity is feasible and should be applied according to the Earth-based guidelines of the AHA/ERC in relation to fundamental statements, like urgent recognition and action, focus on high-quality chest compressions, compression depth and compression-ventilation ratio. However, the special circumstances presented by microgravity and spaceflight must be considered concerning central points such as rescuer position and methods for the performance of chest compressions, airway management and defibrillation.
Original languageEnglish
Publication statusPublished - 5 May 2019
EventAerospace Medical Association Annual Scientific Meeting 2019 - Rio All-Suites Hotel And Casino, Las Vegas, United States
Duration: 5 May 20199 May 2019


ConferenceAerospace Medical Association Annual Scientific Meeting 2019
Abbreviated titleAsMA 2019
Country/TerritoryUnited States
CityLas Vegas


  • CPR Guidelines
  • microgravity
  • Evetts-Russomano
  • Basic Life Support


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