In the next few years, the number of long-term space missions will significantly increase. Providing safe concepts for emergencies including airway management will be a highly challenging task. The aim of the present trial is to compare different airway management devices in simulated microgravity using a free-floating underwater scenario. Five different devices for airway management [laryngeal mask (LM), laryngeal tube (LT), I-GEL, direct laryngoscopy (DL), and video laryngoscopy (VL)] were compared by n = 20 paramedics holding a diving certificate in a randomized cross-over setting both under free-floating conditions in a submerged setting (pool, microgravity) and on ground (normogravity). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the time to ventilation. A total of 20 paramedics (3 female, 17 male) participated in this study. Success rate was highest for LM and LT and was 100% both during simulated microgravity and normogravity followed by the I-GEL (90% during microgravity and 95% during normogravity). However, the success rate was less for both DL (60% vs. 95%) and VL (20% vs. 60%). Fastest ventilation was performed with the LT both in normogravity (13.7 ± 5.3 s; n = 20) and microgravity (19.5 ± 6.1 s; n = 20). For the comparison of normogravity and microgravity, time to ventilation was shorter for all devices on the ground (normogravity) as compared underwater (microgravity). In the present study, airway management with supraglottic airways and laryngoscopy was shown to be feasible. Concerning the success rate and time to ventilation, the optimum were supraglottic airways (LT, LM, I-GEL) as their placement was faster and associated with a higher success rate. For future space missions, the use of supraglottic airways for airway management seems to be more promising as compared to tracheal intubation by DL or VL.

Background: Medical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity. Methods: In this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant freefloating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt.Recently, the International Space Exploration Coordination Group (ISECG) has highlighted Mars as a target in their global exploration roadmap. 1 In the near future, interplanetary long-term missions to Mars and to the Moon will, therefore, soon become reality. 2 There are also private space sector plans for undertaking interplanetary missions, eg SpaceX with the Starship MK1 prototype. 3 These missions could last years and will, consequently, be associated with a significant risk of medical emergencies. 4,5 Conclusively, these missions possess a specific set of challenges for the provision of emergency medicine. 6Given the constraints of long-distance and long-duration interplanetary missions and the delay of data transmission, neither evacuation nor telemedical support would be available in a worstcase scenario. 2 Therefore, crews would be required to manage emergencies alone under conditions of extreme isolation and with significantly limited equipment. Given these circumstances, the development of clear emergency concepts and protocols including universal and easy treatment instructions is essential. 2,6,7 The likelihood that a medical condition potentially requires general anaesthesia (GA) has been estimated to around 2.6%.Other calculations suggest that one major medical event could occur during a 900 day mission. 8 Since one single severe event could lead to the death of a crew member and, therefore, endanger the whole mission, 9 appropriate emergency protocols are of utmost importance.Airway management (endotracheal tube intubation or the use of supraglottic airways) will be an essential and vital skill for crew members to autonomously manage in-mission medical emergencies. 10 Between 1961 and 1999, a total of 17 medical cases involving airway problems (eg inhalation trauma) were documented during space missions. 8 Furthermore, aspiration of small pieces or particles during daily routine could cause significant problems. From present experience, this is not an unlikely event. 11 Notwithstanding the fact that the International Space Station (ISS) has been in operation for over twenty years so far, there is no practical experience pertaining to airway management in real spaceflight conditions yet. 10 Against this backdrop, trials with simulated microgravity offer a useful alternative.Recent trials comparing airway devices i...

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