Technical innovations that may facilitate real-time telementoring of damage control surgery in austere environments: a proof of concept comparative evaluation of the importance of surgical experience, telepresence, gravity and mentoring in the conduct of damage control laparotomies

Kirkpatrick, Andrew W.; LaPorta, Anthony J.; Brien, Susan; Leslie, Tim; Glassberg, Elon; McKee, Jessica; Ball, Chad G.; Wright-Beatty, Heather E.; Keillor, Jocelyn; Roberts, Derek J.; Tien, Homer

doi:10.1503/cjs.014214

Cited by 17 publications

(14 citation statements)

References 10 publications

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“…While basic surgical skills can be acquired promptly [32], an emergency laparotomy performed by a non-physician in space cannot be considered straightforward. Damage control laparotomy in the context of a space mission has however been described by as “technically simple” and potentially “appropriate for telementoring”, which could include the use of pre-recorded video material [12]. It has anecdotally been performed by non-physicians [12].…”

Section: Discussionmentioning

confidence: 99%

“…Damage control laparotomy in the context of a space mission has however been described by as “technically simple” and potentially “appropriate for telementoring”, which could include the use of pre-recorded video material [12]. It has anecdotally been performed by non-physicians [12]. We suggest that the surgical training for non-medical crew members could follow the same model as these anaesthetic techniques, combining reduced hands-on familiarization pre-flight with simplified procedures and smart tools for real-time guidance.…”

Section: Discussionmentioning

confidence: 99%

“…The breadth of the challenges posed by a situation like this happening during an actual mission is impossible to reproduce. Besides their multiple skills, astronauts are also selected for their ability to handle extreme stress, and it is undeniable that they would be among the best candidates, besides actual physicians, to be able to perform such advanced and invasive medical procedures in the most remote setting ever explored by humankind [12]. …”

Section: Discussionmentioning

confidence: 99%

“…To date, no anaesthetic technique or human surgery has been performed in space, besides local infiltration [11, 12]. Advanced surgical procedures have however been performed on animals in low Earth orbit [12].…”

Section: Introductionmentioning

confidence: 99%

“…Advanced surgical procedures have however been performed on animals in low Earth orbit [12]. In 2002, a NASA working group concluded that providing safe anaesthesia during and immediately following the flight could be achievable with enough understanding of the physiological changes affecting the patient [13].…”

Section: Introductionmentioning

confidence: 99%

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Intubation after rapid sequence induction performed by non-medical personnel during space exploration missions: a simulation pilot study in a Mars analogue environment

Komorowski

Fleming

2015

Extrem Physiol Med

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BackgroundThe question of the safety of anaesthetic procedures performed by non anaesthetists or even by non physicians has long been debated. We explore here this question in the hypothetical context of an exploration mission to Mars. During future interplanetary space missions, the risk of medical conditions requiring surgery and anaesthetic techniques will be significant. On Earth, anaesthesia is generally performed by well accustomed personnel. During exploration missions, onboard medical expertise might be lacking, or the crew doctor could become ill or injured. Telemedical assistance will not be available. In these conditions and as a last resort, personnel with limited medical training may have to perform lifesaving procedures, which could include anaesthesia and surgery. The objective of this pilot study was to test the ability for unassisted personnel with no medical training to perform oro-tracheal intubation after a rapid sequence induction on a simulated deconditioned astronaut in a Mars analogue environment. The experiment made use of a hybrid simulation model, in which the injured astronaut was represented by a torso manikin, whose vital signs and hemodynamic status were emulated using a patient simulator software. Only assisted by an interactive computer tool (PowerPoint® presentation), five participants with no previous medical training completed a simplified induction of general anaesthesia with intubation.ResultsNo major complication occurred during the simulated trials, namely no cardiac arrest, no hypoxia, no cardiovascular collapse and no failure to intubate. The study design was able to reproduce many of the constraints of a space exploration mission.ConclusionsUnassisted personnel with minimal medical training and familiarization with the equipment may be able to perform advanced medical care in a safe and efficient manner. Further studies integrating this protocol into a complete anaesthetic and surgical scenario will provide valuable input in designing health support systems for space exploration missions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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