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)
Hinkelbein, Jochen Kerkhoff, Steffen Adler, Christoph Ahlbäck, Anton Braunecker, Stefan Burgard, Daniel Cirillo, Fabrizio De Robertis, Edoardo Glaser, Eckard Haidl, Theresa K
Hinkelbein, Jochen
Kerkhoff, Steffen
Adler, Christoph
Ahlbäck, Anton
Braunecker, Stefan
Burgard, Daniel
Cirillo, Fabrizio
De Robertis, Edoardo
Glaser, Eckard
Haidl, Theresa K
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.
MIDER Authors
Affiliations
German Society of Aviation and Space Medicine; University Hospital of Cologne; European Society of Aerospace Medicine; Fire Department City of Cologne; Örebro University Hospital; University of Florida; Evangelisches Klinikum Niederrhein; Santa Maria delle Grazie Hospital; University of Perugia; University of Cologne; King's College, London; University of Perugia-Terni; Imperial College London; University of Pennsylvania; NHS Greater Glasgow and Clyde; Massachusetts General Hospital; Harvard Medical School; Heidelberg University Hospital; University Hospital Southampton NHS Foundation Trust; AORN Cardarelli; Schön Klinik Düsseldorf; Brest University Hospital; Bretagne Sud General Hospital; Medical and Maritime Simulation Center; University of Bretagne Sud; University Hospitals Birmingham NHS Foundation Trust; Hospital Oldenburg
Date
2020-11-02
Type
Article
Collections
Citation
Hinkelbein J, Kerkhoff S, Adler C, Ahlbäck A, Braunecker S, Burgard D, Cirillo F, De Robertis E, Glaser E, Haidl TK, Hodkinson P, Iovino IZ, Jansen S, Johnson KVL, Jünger S, Komorowski M, Leary M, Mackaill C, Nagrebetsky A, Neuhaus C, Rehnberg L, Romano GM, Russomano T, Schmitz J, Spelten O, Starck C, Thierry S, Velho R, Warnecke T. 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). Scand J Trauma Resusc Emerg Med. 2020 Nov 2;28(1):108. doi: 10.1186/s13049-020-00793-y.