Facing Trauma and Surgical Emergency in Space: Hemorrhagic Shock

Abstract

Although the risk of trauma in space is low, unpredictable events can occur that may require surgical treatment. Hemorrhage can be a life-threatening condition while traveling to another planet and after landing on it. These exploration missions call for a different approach than rapid return to Earth, which is the policy currently adopted on the International Space Station (ISS) in low Earth orbit (LEO). Consequences are difficult to predict, given the still scarce knowledge of human physiology in such environments. Blood loss in space can deplete the affected astronaut’s physiological reserves and all stored crew supplies. In this review, we will describe different aspects of hemorrhage in space, and by comparison with terrestrial conditions, the possible solutions to be adopted, and the current state of the art.

Surgery in the Next Space Missions

“…In laparoscopy, effects on the cardiovascular system in a sick or injured astronaut who has already suffered a decrease in blood volume are not yet well known [15,16,35,36]. A decrease in venous return to the heart could lead to visceral hypoperfusion, and also to reduced blood flow to other organs [15,16,35,36].…”

“…In laparoscopy, effects on the cardiovascular system in a sick or injured astronaut who has already suffered a decrease in blood volume are not yet well known [15,16,35,36]. A decrease in venous return to the heart could lead to visceral hypoperfusion, and also to reduced blood flow to other organs [15,16,35,36]. In addition, other microgravity-induced modifications are present [15], for example, in animal studies [51,52] conducted in parabolic flights, the abdomen was no longer flattened and oval in shape but appeared rounder, displaying an increase in internal volume, allowing easier manipulation of the instruments during the procedure.…”

“…Conclusions were that further investigation is required to define the wound-healing process in space and pave the way for future exploration initiatives beyond low Earth orbit. Results proved that the execution of demanding surgical manoeuvres requiring advanced technical skills is feasible in space although not enough is known yet about the behaviour of human physiology in the case of adverse occurrences requiring major surgery [35,36]. In particular, the anaesthesiologic aspects need to be better studied and assessed due to the insufficient information so far available [17,31].…”

Managing Hemostasis in Space

“…A series of excellent reviews on the topic of external hemorrhage control and emergency surgery in space supports that most diagnostic maneuvers, resuscitative, and surgical interventions required to treat a bleeding astronaut are technically feasible, but quite challenging in the microgravity environment. [62][63][64][65][66] Feasibility of hemostatic surgical procedures was also confirmed in animal models during the Neurolab space shuttle mission. 67 Surgeons have successfully performed damage control surgical procedures using torso hemorrhage simulators during parabolic flight.…”

Beyond the Blue Planet: Risk Management Strategies for Space Programs

“…Failures of Space Vehicles: Spacecraft are complex engineering products and there is always a risk of failure. Problems such as repairing malfunctions in space, remote intervention, and limited resources can endanger the lives of the crew (Pantalone et al, 2022).…”