Abstract
Background
As mankind strives to explore space beyond the moon by planning space exploration missions to Mars and as space tourism becomes closer to operational viability, medical planning for those missions must consider the possibility of life threatening medical emergencies. For Earth, well-established and proven guidelines concerning cardiopulmonary resuscitation (CPR) are published. Nevertheless,such a guideline does not exist for the special environment of microgravity, despite mankind is exploring space since 1961. Nonetheless, several studies have been conducted to investigate the feasibility and best technique of CPR in microgravity. The aim of this guideline is to critically appraise all the literature of CPR in weightlessness and create the most up to date evidence-based guidance for its application under the special circumstances of spaceflight.
Methods
A task force was created by the German Society of Aerospace Medicine (DGLRM) to develop a guideline for CPR in weightlessness, based on the member’s clinical and scientific background. Then standardized questions using the PICO-model were created, to guide the systematic literature review, which was mainly performed using “PubMed”. The retrieved 4,356 abstracts were then screened using the browser-based tool “abstrackr” in double-reviewer technique, and the selected papers were subsequently reviewed utilizing the GRADE-method. The guideline was then divided into 15 sections and the recommendations for each section were finalized by 2 experts. All proposed recommendations were then presented to the whole task force and subject to a structured consensus finding process using the RAND-DELPHI method.
Results Similar to Earth-based guidelines, a differentiated approach to CPR with a division into basic life support (BLS) and advanced life support (ALS) is necessary for the special environment of microgravity. 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.Conclusion 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.
As mankind strives to explore space beyond the moon by planning space exploration missions to Mars and as space tourism becomes closer to operational viability, medical planning for those missions must consider the possibility of life threatening medical emergencies. For Earth, well-established and proven guidelines concerning cardiopulmonary resuscitation (CPR) are published. Nevertheless,such a guideline does not exist for the special environment of microgravity, despite mankind is exploring space since 1961. Nonetheless, several studies have been conducted to investigate the feasibility and best technique of CPR in microgravity. The aim of this guideline is to critically appraise all the literature of CPR in weightlessness and create the most up to date evidence-based guidance for its application under the special circumstances of spaceflight.
Methods
A task force was created by the German Society of Aerospace Medicine (DGLRM) to develop a guideline for CPR in weightlessness, based on the member’s clinical and scientific background. Then standardized questions using the PICO-model were created, to guide the systematic literature review, which was mainly performed using “PubMed”. The retrieved 4,356 abstracts were then screened using the browser-based tool “abstrackr” in double-reviewer technique, and the selected papers were subsequently reviewed utilizing the GRADE-method. The guideline was then divided into 15 sections and the recommendations for each section were finalized by 2 experts. All proposed recommendations were then presented to the whole task force and subject to a structured consensus finding process using the RAND-DELPHI method.
Results Similar to Earth-based guidelines, a differentiated approach to CPR with a division into basic life support (BLS) and advanced life support (ALS) is necessary for the special environment of microgravity. 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.Conclusion 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 language | English |
|---|---|
| Type | Saving lives in spaceflight - a guideline for cardiopulmonary resuscitation in microgravity |
| Media of output | Poster |
| Publication status | Published - 12 Oct 2018 |
Keywords
- CPR
- Microgravity
- Spaceflight
- Manned Missions