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Abstract

Performing life-saving treatment is difficult in special circumstances. An astronaut in microgravity could suffer a cardiac arrest and might need immediate cardiopulmonary resuscitation. Traumatic causes may cause a cardiac arrest. The spectrum of therapeutic interventions ranges from the initiation of chest compressions for resuscitation, to intubation. There are five previously described methods that deal with the solution of this problem. Special defibrillators have to be used in space, so they don’t interfere with the electronics of the space station The astronauts have to adapt the way they insert and deliver drips with drugs and adrenaline into the patient’s vein. Syringes might be bubble-free. The thing is that it is necessity to have bubble filters for the syringe.
CPR in Space
Prof. Mirjana Shosholcheva
Department of Anaesthesia and Intensive Care
Faculty of Medicine-Skopje, Macedonia
"Imagine, for a moment, trying to
deliver cardiac compressions while
floating weightlessly in orbit,"
How do astronauts perform life saving
treatment in zero gravity?
And were are right to think it
And were are right to think it
must be complicated!
must be complicated!
Key points
An astronaut in microgravity could suffer a cardiac arrest
and need immediate cardiopulmonary resuscitation
Traumatic causes may cause a cardiac arrest
The spectrum of therapeutic interventions ranges from the
initiation of chest compressions for resuscitation,
to intubation
CPR (Cardio pulmonary resuscitation)
a well-known emergency procedure here on Earth,
administered to someone whose heart has stopped beating.
Chest compressions of at least 5 cm deep are given at a rate
of 100 per minute to try and manually pump blood through
the heart and body
Not too difficult to perform on Earth but what
happens in the microgravity of Space?
To be more precise, what we think of as our weight, is actually the force with which
our body is attracted towards the Earth.
When we are in space we do not feel
gravitational attraction to the Earth and so
effectively, we are weightless.
When we are in space we do not feel
gravitational attraction to the Earth and so
effectively, we are weightless.
Therefore, giving chest compressions depends more on
the force and strength of the arms of the person
providing the CPR
Therefore, giving chest compressions depends more on
the force and strength of the arms of the person
providing the CPR
On Earth we use the weight of our
bodies to make the compressions – but
in space our body weights nothing!
On Earth we use the weight of our
bodies to make the compressions – but
in space our body weights nothing!
Body suspension device with mannequin
fully suspended simulated microgravity
All astronauts receive a basic level of medical training as
part of their specialized astronaut technical training
In the context of future space exploration (e.g., a mission to Mars),
the longer duration of missions and consecutively higher risk
of an incident requiring resuscitation, increase the importance
of microgravity-appropriate medical techniques
Adequate cardio-pulmonary resuscitation techniques
in space (microgravity and weightlessness
Main problem:
Attempting compressions of the chest in microgravity
onlyleads to pushing away from each other, without achieving
a haemodynamically significant cardiac output (CO) in the patient.
Lack of gravity
Everything is floating - including
you and the person who need
assistance!
If you try to compress the chest as you do on Earth, the force
you apply will generate a reaction force in the opposite direction
(Newton
Newton’s Laws of Motion
’s Laws of Motion) – simply put, you will float away
from the person you are trying to help!
There are five described methods that deal with
There are five described methods that deal with
the solution of this problem
the solution of this problem
“Standard side straddle (STD) method”
“Waist Straddling maneuver (SM)”
“Reverse Bear Hug (RBH) method”
“Evetts-Russomano (ER) method”
“Handstand (HS) method”
Techniques
The rescuer places him sideways and
the patient is situated on the crew medical restraint
system for CPR.
Standard side straddle (STD) method
Waist Straddling manoeuvre (SM)
The rescuer straddled the patient’s
waist, with the patient situated on the crew medical
restraint system for CPR.
The rescuer grips the patient from the
back with both arms and performs compressions
Reverse Bear Hug (RBH) method
In the ER method, the rescuer places
himself on top of the patient. He places his left leg
over the right shoulder of the patient. The right leg of
the rescuer is placed around the patient’s
back under the left arm.
The chest compression applied against the sternum is
countered by the force exerted by the rescuers’s
crossed legs.
Evetts-Russomano (ER) method
Evetts-Russomano (ER) method
To carry out the HS method, the rescuer places his feet on one
wall of the cabin, with the patient’s back against the opposite
wall, and the chest compressions are applied against the
sternum
Handstand (HS) method
The HS method is superior in both the pure
compression depth
Handstand (HS) method
However, this technique requires a specific setting (wall-to-wall
distance below 2. 5m) not being present at every location in space. In
such a case, the ER technique is a reasonable alternative
What does this mean for future space missions?
It is unlikely that BLS can be carried out with the
same performance in space as on earth
Even under ideal conditions not every CPR is
able to achieve a return of spontaneous
circulacion
When a shock is being applied in a regular operating
theatre, no one can touch the patient because of the
powerful electromagnetic current
But in space?
Defibrillators in space
In space, the application of a defibrillator is not so much a problem – it’s the electric current that poses an obstacle:
:
In space, other crew members are floating around
and astronaut chairs could be conductive
– if you need to defibrillate
[or shock] the patient
Special defibrillators have to be used, so they don’t interfere
with the electronics of the space station
the question is how do you do it
without shocking everybody else
around you?’
NASA announced in 2008 the Lifepak 1000
defibrillator as being deployed on the International
Space Station (ISS) as the first automated
external defibrillator (AED) in space
Evaluations of the defibrillators included:
- user interface analysis
-ease of use
-durability and detailed technical specifications related to the
unique conditions encountered in space
Analysis and testing for electromagnetic interference, pressure
susceptibility, temperature, vibration, acceleration and other
environmental factors
Management with drugs
The thing you need to have is bubble filters for your syringe
Make syringes bubble-free
You need to account for how liquids move in space?
The astronauts have to adapt the way they insert and deliver drips
with drugs and adrenaline into the patient's vein
On Earth, bubbles float to the surface, but in space they spread
themselves through the liquid, because of lack of gravity
Without filters, you deal with an emulsion of bubbles
suspended in the solution, and you'd just be injecting air
Come back to the Earth!
Once you've got the patient's circulation going, he is
still going to need intensive care, including
ventilators and drugs that promote circulation
According to facts, the International Space Stations have
less medical equipment and expertise than an average
ambulance
So you need to get the victim home as
quickly as possible, which is tricky
An illustration of the Mars MAVEN spacecraft, which
launched in fall 2013

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