Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review

Abstract

Introduction:Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.Methods:PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.Results:The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles.Discussion:The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.

Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy

“…This data reflects the success of safety policies and space medicine, implementing drastic preventive actions and countermeasures to control medical risks in orbital stations. In addition, astronauts have therapeutics options to stabilize early-stage lung conditions (i.e., antibiotics for pulmonary infection) and to rapidly return to Earth within a few hours in case of a looming respiratory threat, leaving an on-board intubation to a worst-case scenario with a very low probability event 25 , 26 .…”

“…Mastering alternative oxygenation strategies 64 , correct drug storage and preparation, management of early and late intubation side effects, sustained oxygen delivery and optionally aeromedical evacuation with continuous care 65 and extubation readiness criteria are some of the unresolved questions raised by an airway emergency in space. To date, no evacuation of a critically ill or intubated patient is possible onboard the current space vehicles 26 and “space ambulances”, allowing evacuation of a critical ill from Low Earth Orbit to a Definitive Medical Care Facility once evoked, were abandoned 66 . Many ethical issues related to anesthesia and critical care provisions in austere environments are still open, far beyond technical consideration related to the sole criteria of laryngoscopy 23 , 32 , 67 – 70 .…”

“…It could allow the caregiver to have a counter surface (the patient’s chest) to stabilize himself with his knees while performing the procedure, and potentially offering more biomechanical strengths to expose the glottic plan by using glenohumeral retraction forces rather than protraction 78 , 79 . Additionally, preparation and setup for airway management could also compete with some specific chest compression positioning in weightlessness, such as the “reverse bear hug” technique, performed by operator behind the patient 26 , 80 .…”