Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation

Abstract

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.

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

“…Regarding the ice-pick intubation with a direct laryngoscope, this approach remained difficult even for trained operators, as they had a poor and unacceptable first pass success rate (33%) and a low confidence score with this technique. This success rate among experts is similar to those obtained under other free-floating configurations 8 , 11 , 12 .…”

“…Recent results confirm that weightlessness is a constraint that impairs the safety of intubation by lowering the probability of first-pass success and delaying the time to provide the first ventilation 10 – 12 . When performed with a classic direct laryngoscope by novices, oro-tracheal intubation attempts lead to unacceptable high failure rates in both tethered and free-floating positions 8 .…”

“…Other complications include unrecognized misplacement, secondary dislodgement, laryngeal trauma and hemodynamic response such as bradycardia for examples 5 , 6 . Defining the scope of this medical procedure in spaceflight conditions, especially under the constraint of weightlessness, has been tested in many medical simulations (underwater and parabolic flight studies) 7 – 12 .…”

Supraglottic Airway Devices: Present State and Outlook for 2050

“…Still others feature higher device conditioning stiffness and friction coefficients, have a thicker cuff and/or a higher cuff profile, for example, LMA ® -ProSeal™ ,a , 12 LMA ® -Protector™ ,b , 13 Baska-Mask, 14 streamlined liner of the pharynx airway (SLIPA). 15 Therefore, use of some SGDs requires more training, 16,17 and additional adjunct devices may be necessary, such as, for example, an introducer, a stylet, a gum elastic bougie, a gastric tube, [18][19][20] while others can be readily inserted by novices. 21,22 Some SGDs have a preshaped, anatomically curved tube following the normal oropharynx anatomy, or include a fixation tab.…”

30 years of CNES parabolic flights for the benefit of the scientific community

“…Above all, it continues to shed light on the mechanisms of human physiology, even during short duration microgravity conditions. Parabolic flights offer a test platform to specifically study physiology or neurology, as cardiovascular adaptation, motor adaptation or environment perception perturbation [11][12][13][14][15][16][17][18][19]. Longer stays in a microgravity environment have effects on the human body that are very similar to those of ageing (loss of bone and muscle mass, degradation of arteries, etc.).…”