Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG)

Abstract

Background With the “Artemis”-mission mankind will return to the Moon by 2024. Prolonged periods in space will not only present physical and psychological challenges to the astronauts, but also pose risks concerning the medical treatment capabilities of the crew. So far, no guideline exists for the treatment of severe medical emergencies in microgravity. We, as a international group of researchers related to the field of aerospace medicine and critical care, took on the challenge and developed a an evidence-based guideline for the arguably most severe medical emergency – cardiac arrest. Methods After the creation of said international group, PICO questions regarding the topic cardiopulmonary resuscitation in microgravity were developed to guide the systematic literature research. Afterwards a precise search strategy was compiled which was then applied to “MEDLINE”. Four thousand one hundred sixty-five findings were retrieved and consecutively screened by at least 2 reviewers. This led to 88 original publications that were acquired in full-text version and then critically appraised using the GRADE methodology. Those studies formed to basis for the guideline recommendations that were designed by at least 2 experts on the given field. Afterwards those recommendations were subject to a consensus finding process according to the DELPHI-methodology. Results 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 tracheal intubation (TI) are involved. Discussion 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.

Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity—A Manikin Study

“…In recent studies, the Handstand method (HS) proved to deliver the most effective chest compressions with regards to the 2021 ERC guidelines [14]. The recently published international guidelines for CPR in microgravity [15] recommend the ER method as the primary method for basic life support in microgravity because of its advantages in feasibility and independence of cabin diameter. Normally, emergency equipment is stored near the Crew Medical Restraint System; thus, transport of a patient undergoing CPR is possible.…”

“…Current guidelines recommend a compression rate of 100-120/min with a compression depth of a minimum of 50 to a maximum 60 mm. Moreover, recently published guidelines on CPR in microgravity follow mainly ERC recommendations for CPR [15]. In recent years, research has been undertaken to develop methods of CPR in microgravity; thus far, five different methods have been described [2,6,16].…”

Evaluation neuer Methoden zur Atemwegssicherung bei Langzeitmissionen im Weltall

“…Auch eine kurzfristige kardiopulmonale Reanimation (CPR) bei potenziell reversibler Ursache erscheint denkbar und würde ein rasches Atemwegsmanagement erfordern. Entsprechende Leitlinien zur CPR im Weltraum wurden erarbeitet und jüngst publiziert [26], ebenso Konzepte zur anschließenden Hypothermie [27].…”

Facing Trauma and Surgical Emergency in Space: Hemorrhagic Shock

“…Treatment of unforeseen health events in space is a major concern that can jeopardize crew health and mission success (Hamilton et al, 2008;Alexander 2016;Patel et al, 2020). This concern has given rise to several studies on open surgery, laparoscopic surgery, and robot-assisted surgery as well as studies of human physiology in microgravity (for a review of the literature, see Panesar et al, 2018(Melton et al, 2001Campbell 2002;Dawson, 2008;Kirkpatrick et al, 2009a;Kirkpatrick et al, 2009b;Kirkpatrick et al, 2009c;Doarn et al, 2009;Pletser et al, 2009;Haidegger et al, 2011;Canga et al, 2016;Ashrafian et al, 2017;Panesar and Ashkan 2018;Baker et al, 2019;Hinkelbein et al, 2020;Kirkpatrick et al, 2020;Robertson et al, 2020). Although in space the risk of trauma is low, objects in movement conserve their mass and still carry a kinetic energy (Komorowski et al, 2018;STEMonstrations 2022) so that damages to the human body are likely to occur.…”