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Thierry S, Jaulin F, Starck C, Ariès P, Schmitz J, Kerkhoff S, Bernard CI, Komorowski M, Warnecke T, Hinkelbein J. Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy. NPJ Microgravity 2023; 9:73. [PMID: 37684267 PMCID: PMC10491756 DOI: 10.1038/s41526-023-00314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/02/2023] [Indexed: 09/10/2023] Open
Abstract
Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.
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Affiliation(s)
- Séamus Thierry
- Anaesthesiology Department, South Brittany General Hospital, 56100, Lorient, France.
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.
- Medical Simulation Centre B3S, 56100, Lorient, France.
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France.
| | - François Jaulin
- Sorbonne Medical University, Assistance Publique des Hôpitaux de Paris, Paris, France
- Human Factor in Healthcare Association, Group FHS, Paris, France
| | - Clément Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Philippe Ariès
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Jan Schmitz
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Steffen Kerkhoff
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Cécile Isabelle Bernard
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France
| | - Matthieu Komorowski
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tobias Warnecke
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Jochen Hinkelbein
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
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Pantalone D. Surgery in the Next Space Missions. Life (Basel) 2023; 13:1477. [PMID: 37511852 PMCID: PMC10381631 DOI: 10.3390/life13071477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 04/21/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
In the coming years, missions to the Moon and Mars shall be the new goals of space flight. The complexity of these missions due to the great distance from Earth and the unforeseen obstacles to settle on another planet have given rise to great concerns for crew health and survival. The need for advanced crew autonomy and a different approach to surgical emergency require new protocols and devices to help future crew medical officers and other crew members in a task of unprecedented difficulty. Hence, the increasing variety of schedules, devices, and protocols being developed. A serious health problem, such as an emerging surgical disease or severe trauma, can jeopardize the mission and survival of the entire crew. Many other difficulties are present in deep-space missions or settlements on other planets, such as communication and supply, also medical, delays, and shortage, and the presence of radiation. Progress in advanced technologies as well as the evolution of robotic surgery and the use of artificial intelligence are other topics of this review. In this particular area of research, even if we are still very far from an "intelligent robot", this evolution must be evaluated in the light of legislative and ethical considerations. This topic was presented at the annual meeting of the American College of Surgeons-Italy Chapter in 2021.
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Affiliation(s)
- Desiree Pantalone
- American College of Surgeons, FACS, Chicago, IL 60611, USA
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Emergency Surgery Unit-Trauma Team, Trauma Center, Careggi University Hospital, 50134 Florence, Italy
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Overbeek R, Schmitz J, Rehnberg L, Benyoucef Y, Dusse F, Russomano T, Hinkelbein J. Effectiveness of CPR in Hypogravity Conditions-A Systematic Review. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121958. [PMID: 36556323 PMCID: PMC9785883 DOI: 10.3390/life12121958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
(1) Background: Cardiopulmonary resuscitation (CPR), as a form of basic life support, is critical for maintaining cardiac and cerebral perfusion during cardiac arrest, a medical condition with high expected mortality. Current guidelines emphasize the importance of rapid recognition and prompt initiation of high-quality CPR, including appropriate cardiac compression depth and rate. As space agencies plan missions to the Moon or even to explore Mars, the duration of missions will increase and with it the chance of life-threatening conditions requiring CPR. The objective of this review was to examine the effectiveness and feasibility of chest compressions as part of CPR following current terrestrial guidelines under hypogravity conditions such as those encountered on planetary or lunar surfaces; (2) Methods: A systematic literature search was conducted by two independent reviewers (PubMed, Cochrane Register of Controlled Trials, ResearchGate, National Aeronautics and Space Administration (NASA)). Only controlled trials conducting CPR following guidelines from 2010 and after with advised compression depths of 50 mm and above were included; (3) Results: Four different publications were identified. All studies examined CPR feasibility in 0.38 G simulating the gravitational force on Mars. Two studies also simulated hypogravity on the Moon with a force of 0.17 G/0,16 G. All CPR protocols consisted of chest compressions only without ventilation. A compression rate above 100/s could be maintained in all studies and hypogravity conditions. Two studies showed a significant reduction of compression depth in 0.38 G (-7.2 mm/-8.71 mm) and 0.17 G (-12.6 mm/-9.85 mm), respectively, with nearly similar heart rates, compared to 1 G conditions. In the other two studies, participants with higher body weight could maintain a nearly adequate mean depth while effort measured by heart rate (+23/+13.85 bpm) and VO2max (+5.4 mL·kg-1·min-1) increased significantly; (4) Conclusions: Adequate CPR quality in hypogravity can only be achieved under increased physical stress to compensate for functional weight loss. Without this extra effort, the depth of compression quickly falls below the guideline level, especially for light-weight rescuers. This means faster fatigue during resuscitation and the need for more frequent changes of the resuscitator than advised in terrestrial guidelines. Alternative techniques in the straddling position should be further investigated in hypogravity.
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Affiliation(s)
- Remco Overbeek
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Correspondence:
| | - Jan Schmitz
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), 51149 Cologne, Germany
| | - Lucas Rehnberg
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- InnovaSpace, London SE28 0LZ, UK
| | - Yacine Benyoucef
- Spacemedex, Valbonne Sophia-Antipolis, 06560 Valbonne, France
- Department of Physiatry and Nursing, Faculty of Health Sciences, IIS Aragon, University of Zaragoza, 50009 Zaragoza, Spain
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | | | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), 80331 Munich, Germany
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), 51149 Cologne, Germany
- Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes-Wesling-Universitätsklinikum Minden, Ruhr-Universität Bochum, 32429 Minden, Germany
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Pantalone D, Chiara O, Henry S, Cimbanassi S, Gupta S, Scalea T. Facing Trauma and Surgical Emergency in Space: Hemorrhagic Shock. Front Bioeng Biotechnol 2022; 10:780553. [PMID: 35845414 PMCID: PMC9283715 DOI: 10.3389/fbioe.2022.780553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Although the risk of trauma in space is low, unpredictable events can occur that may require surgical treatment. Hemorrhage can be a life-threatening condition while traveling to another planet and after landing on it. These exploration missions call for a different approach than rapid return to Earth, which is the policy currently adopted on the International Space Station (ISS) in low Earth orbit (LEO). Consequences are difficult to predict, given the still scarce knowledge of human physiology in such environments. Blood loss in space can deplete the affected astronaut’s physiological reserves and all stored crew supplies. In this review, we will describe different aspects of hemorrhage in space, and by comparison with terrestrial conditions, the possible solutions to be adopted, and the current state of the art.
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Affiliation(s)
- D. Pantalone
- Department of Experimental and Clinical Medicine, Fellow of the American College of Surgeons, Core Board and Head for Studies on Traumatic Events and Surgery in the European Space Agency-Topical Team on “Tissue Healing in Space Techniques for Promoting and Monitoring Tissue Repair and Regeneration” for Life Science Activities Agency, Assistant Professor in General Surgery, Specialist in Vascular Surgery, Emergency Surgery Unit–Trauma Team, Emergency Department–Careggi University Hospital, University of Florence, Florence, Italy
- *Correspondence: D. Pantalone,
| | - O. Chiara
- Fellow of the American College of Surgeons, Director of General Surgery–Trauma Team, ASST GOM Grande Ospedale Metropolitano Niguarda, Professor of Surgery, University of Milan, Milan, Italy
| | - S. Henry
- Fellow of the American College of Surgeons, Director Division of Wound Healing and Metabolism, R Adams Cowley Shock Trauma Center University of Maryland, Baltimore, MD, United States
| | - S. Cimbanassi
- Fellow of the American College of Surgeons, EMDM, Vice Director of General Surgery-Trauma Team, ASST GOM Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S. Gupta
- Fellow of the American College of Surgeons, R Adams Cowl y Shock Trauma Center, University of Maryland, Baltimore, MD, United States
| | - T. Scalea
- Fellow of the American College of Surgeons, The Honorable Francis X. Kelly Distinguished Professor of Trauma Surgery.Physician-in-Chief, R Adams Cowley Shock Trauma Center, System Chief for Critical Care Services, University of Maryland Medical System, University of Maryland, Baltimore, MD, United States
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Running Experimental Research of a Cable-Driven Astronaut on-Orbit Physical Exercise Equipment. MACHINES 2022. [DOI: 10.3390/machines10050377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Manned spaceflight has already become an important approach to space science exploration, while long-term exposure to the microgravity environment will lead to severe health problems for astronauts, including bone loss, muscle atrophy, and cardiovascular function decline. In order to mitigate or eliminate those negative influences, this paper presents a cable-driven exercise equipment that can be applied in a microgravity environment to render multi-functional on-orbit physical exercise modes for astronauts. First, the structure of cable module and the configuration of the equipment were proposed. Second, a two-level controller was provided, including the cable tension distribution algorithm and tension controller of the cable module. A safety protection strategy was proposed to ensure the safety of the astronaut. Furthermore, simulation and running experiment studies of the equipment were conducted, the results demonstrate that the load force of the equipment could achieve a high-level accuracy, and the exercise status of the astronaut could be monitored and protected in the meantime. Therefore, physical exercises could be carried out by the assistance of the equipment to keep astronauts in good shape on-orbit.
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A Study on the Role of Intelligent Medical Simulation Systems in Teaching First Aid Competence in Anesthesiology. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8163546. [PMID: 35494522 PMCID: PMC9050259 DOI: 10.1155/2022/8163546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
Anesthesiology is a subject with strong practicality and application. Undergraduate anesthesiology teaching needs to strike a balance between theoretical knowledge, clinical skill training, and clinical thinking development. Clinical probation and practice are an important part of undergraduate anesthesia teaching. Traditional clinical teaching uses real patients for demonstration and training, but as patients become more self-protective and less cooperative, there are not enough patients for clinical skill training. Simulation is to teach medical scenes in real life under the control of standardized technical guidelines and parameters. Since then, with the rapid development of computer technology, simulation technology and simulation teaching have been greatly developed and are more and more used in clinical teaching, skill evaluation, and scientific research. This study explores the effective methods of clinical teaching in anesthesiology by comparing the effectiveness of traditional teaching methods and simulation teaching methods in undergraduate clinical teaching. It is difficult to combine theory and practice in first aid, which does not allow them to directly receive and deal with emergency medical treatment and resuscitation. In China's current medical environment and patients' high demand for medical services, it is imperative to vigorously carry out simulated medical education. In the eastern part of Inner Mongolia, according to the advantages of teaching hospitals, our hospital took the lead in carrying out the simulation education project, which is still in the exploratory stage and not systematic enough. This study will help us to better carry out simulation teaching and improve the clinical skills of medical students in the future. Methods. The student group and class took the advanced simulator training as the experimental group, applied the advanced integrated simulator and other systems of the Norwegian company, referred to the international guidelines for cardiopulmonary resuscitation and cardiovascular first aid in 2005, and practiced in the emergency department during the clinical internship and “emergency clinical simulation training” course. The course includes basic life support, advanced life support, and comprehensive training of CPR (cardiopulmonary resuscitation) and endotracheal intubation. Results. The passing rate of simulated first aid practice was 94.4%; 100% of the students think it is necessary to set up the course, 91% of the students think it is practical, 91% of the students think the course content is reasonable and perfect, and 77%–100% of the students think the course has improved their first aid operation ability, comprehensive application of knowledge, and clinical thinking ability. Conclusion. Carrying out the course of “clinical simulated first aid training” through the advanced simulator system can effectively improve the interns' clinical first aid operation ability, teamwork ability, and self-confidence, improve the students' clinical thinking and judgment ability, and improve the service level to patients.
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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Randomized Comparison of Two New Methods for Chest Compressions during CPR in Microgravity-A Manikin Study. J Clin Med 2022; 11:jcm11030646. [PMID: 35160097 PMCID: PMC8836939 DOI: 10.3390/jcm11030646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/17/2022] Open
Abstract
Background: Although there have been no reported cardiac arrests in space to date, the risk of severe medical events occurring during long-duration spaceflights is a major concern. These critical events can endanger both the crew as well as the mission and include cardiac arrest, which would require cardiopulmonary resuscitation (CPR). Thus far, five methods to perform CPR in microgravity have been proposed. However, each method seems insufficient to some extent and not applicable at all locations in a spacecraft. The aim of the present study is to describe and gather data for two new CPR methods in microgravity. Materials and Methods: A randomized, controlled trial (RCT) compared two new methods for CPR in a free-floating underwater setting. Paramedics performed chest compressions on a manikin (Ambu Man, Ambu, Germany) using two new methods for a free-floating position in a parallel-group design. The first method (Schmitz–Hinkelbein method) is similar to conventional CPR on earth, with the patient in a supine position lying on the operator’s knees for stabilization. The second method (Cologne method) is similar to the first, but chest compressions are conducted with one elbow while the other hand stabilizes the head. The main outcome parameters included the total number of chest compressions (n) during 1 min of CPR (compression rate), the rate of correct chest compressions (%), and no-flow time (s). The study was registered on clinicaltrials.gov (NCT04354883). Results: Fifteen volunteers (age 31.0 ± 8.8 years, height 180.3 ± 7.5 cm, and weight 84.1 ± 13.2 kg) participated in this study. Compared to the Cologne method, the Schmitz–Hinkelbein method showed superiority in compression rates (100.5 ± 14.4 compressions/min), correct compression depth (65 ± 23%), and overall high rates of correct thoracic release after compression (66% high, 20% moderate, and 13% low). The Cologne method showed correct depth rates (28 ± 27%) but was associated with a lower mean compression rate (73.9 ± 25.5/min) and with lower rates of correct thoracic release (20% high, 7% moderate, and 73% low). Conclusions: Both methods are feasible without any equipment and could enable immediate CPR during cardiac arrest in microgravity, even in a single-helper scenario. The Schmitz–Hinkelbein method appears superior and could allow the delivery of high-quality CPR immediately after cardiac arrest with sufficient quality.
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Robot-assisted surgery in space: pros and cons. A review from the surgeon's point of view. NPJ Microgravity 2021; 7:56. [PMID: 34934056 PMCID: PMC8692617 DOI: 10.1038/s41526-021-00183-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/24/2021] [Indexed: 12/12/2022] Open
Abstract
The target of human flight in space has changed from permanence on the International Space Station to missions beyond low earth orbit and the Lunar Gateway for deep space exploration and Missions to Mars. Several conditions affecting space missions had to be considered: for example the effect of weightlessness and radiations on the human body, behavioral health decrements or communication latency, and consumable resupply. Telemedicine and telerobotic applications, robot-assisted surgery with some hints on experimental surgical procedures carried out in previous missions, had to be considered as well. The need for greater crew autonomy in health issues is related to the increasing severity of medical and surgical interventions that could occur in these missions, and the presence of a highly trained surgeon on board would be recommended. A surgical robot could be a valuable aid but only inasfar as it is provided with multiple functions, including the capability to perform certain procedures autonomously. Space missions in deep space or on other planets present new challenges for crew health. Providing a multi-function surgical robot is the new frontier. Research in this field shall be paving the way for the development of new structured plans for human health in space, as well as providing new suggestions for clinical applications on Earth.
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On the Challenges of Anesthesia and Surgery during Interplanetary Spaceflight. Anesthesiology 2021; 135:155-163. [PMID: 33940633 DOI: 10.1097/aln.0000000000003789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Warnecke T, Dauth L, Ahlbäck A, DuCanto J, Fleischhammer E, Glatz C, Kerkhoff S, Mathes A, Schmitz J, Starck C, Thierry S, Hinkelbein J. Time to ventilation and success rate of airway devices in microgravity: A randomized crossover manikin-trial using an underwater setting. Acta Anaesthesiol Scand 2021; 65:681-687. [PMID: 33440015 DOI: 10.1111/aas.13780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity. METHODS In this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant free-floating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt. RESULTS A total of 20 participants performed placement of each device in both gravity conditions in an Airway mannequin. The fastest time to initial ventilation in simulated microgravity was possible with the laryngeal tube (18.9 ± 8 seconds) followed by laryngeal mask (20.1 ± 9 seconds). The I-gel® supraglottic airway device required substantially more time for successful insertion in simulated microgravity (35.4 ± 25 seconds) as did endotracheal tube intubation by direct laryngoscopy (70.4 ± 35 seconds). Simulated microgravity conditions prolonged time to initial ventilation by 3.3 seconds (LM), 3.9 seconds (LT), 19.9 seconds (I-gel) and 43.1 seconds (endotracheal intubation, ETI) when compared to poolside attempts in normogravity. CONCLUSION In simulated microgravity conditions, use of the laryngeal tube or laryngeal mask provided the quickest time to initial ventilation, without deliberate tethering of the mannequin and rescuer to a fixed surface. Endotracheal intubation required significantly longer procedure times and, thus, was considered insufficient for clinical use in microgravity.
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Affiliation(s)
- Tobias Warnecke
- Department of Anaesthesiology Critical Care Emergency Medicine and Pain Therapy Hospital of OldenburgMedical Campus University of Oldenburg Oldenburg Germany
| | - Lisa Dauth
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Anton Ahlbäck
- Department of Anaesthesiology and Intensive Care Örebro University Hospital Örebro Sweden
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
| | - James DuCanto
- Department of Anaesthesiology Medical College of WisconsinAurora St. Luke's Medical Center Milwaukee WI USA
| | - Elisabeth Fleischhammer
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Carlos Glatz
- Department Medicine Goethe University Frankfurt am Main Frankfurt Germany
| | - Steffen Kerkhoff
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
| | - Alexander Mathes
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
| | - Clement Starck
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- Anesthesiology and Intensive Care Department University Hospital of Brest Brest France
| | - Seamus Thierry
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- Anesthesiology Department South Brittany General Hospital Lorient France
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
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Hinkelbein J, Ahlbäck A, Antwerber C, Dauth L, DuCanto J, Fleischhammer E, Glatz C, Kerkhoff S, Mathes A, Russomano T, Schmitz J, Starck C, Thierry S, Warnecke T. Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation. Sci Rep 2021; 11:9286. [PMID: 33927212 PMCID: PMC8085007 DOI: 10.1038/s41598-021-88008-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
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.
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany. .,German Society of Aerospace Medicine (DGLRM), Munich, Germany.
| | - Anton Ahlbäck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anaesthesiology and Intensive Care, Örebro University Hospital , Örebro, Sweden
| | - Christine Antwerber
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Lisa Dauth
- Department for Anaesthesiology and Intensive Care Medicine, St. Elisabeth Hospital, Cologne, Germany
| | - James DuCanto
- Department of Anaesthesiology, Medical College of Wisconsin, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Elisabeth Fleischhammer
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Carlos Glatz
- Department of Medicine, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Steffen Kerkhoff
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Alexander Mathes
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thais Russomano
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Clement Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anaesthesiology and Intensive Care Department, University Hospital of Brest, Brest, France
| | - Seamus Thierry
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anaesthesiology Department, South Brittany General Hospital, Lorient, France
| | - Tobias Warnecke
- Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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13
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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; 28:108. [PMID: 33138865 PMCID: PMC7607644 DOI: 10.1186/s13049-020-00793-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Jochen Hinkelbein
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany. .,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany. .,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.
| | - Steffen Kerkhoff
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
| | - Christoph Adler
- Department of Internal Medicine III, Heart Centre of the University of Cologne, Cologne, Germany.,Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany
| | - Anton Ahlbäck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Stefan Braunecker
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Daniel Burgard
- Department of Cardiology and Angiology, Heart Center Duisburg, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - Fabrizio Cirillo
- Department of Anaesthesia and Intensive Care, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Edoardo De Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Eckard Glaser
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,, Gerbrunn, Germany
| | - Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Pete Hodkinson
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Aerospace Medicine, Centre of Human and Applied Physiological Sciences, King's College, London, UK
| | - Ivan Zefiro Iovino
- Department of Anaesthesia and Intensive Care, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50937, Cologne, Germany
| | | | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Matthieu Komorowski
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Exhibition road, London, SW7 2AZ, UK
| | - Marion Leary
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Mackaill
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Accident and Emergency Department, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Alexander Nagrebetsky
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christopher Neuhaus
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucas Rehnberg
- University Hospital Southampton NHS Foundation Trust, Anaesthetic Department, Southampton, UK
| | | | - Thais Russomano
- Centre of Human and Applied Physiological Sciences, Kings College London, London, UK
| | - Jan Schmitz
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
| | - Oliver Spelten
- Department of Anaesthesiology and Intensive Care Medicine, Schön Klinik Düsseldorf, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Germany
| | - Clément Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anesthesiology Department, Brest University Hospital, Brest, France
| | - Seamus Thierry
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anesthesiology Department, Bretagne Sud General Hospital, Lorient, France.,Medical and Maritime Simulation Center, Lorient, France.,Laboratory of Psychology, Cognition, Communication and Behavior, University of Bretagne Sud, Vannes, France
| | - Rochelle Velho
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, University Hospitals Birmingham, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tobias Warnecke
- University Department for Anesthesia, Intensive and Emergency Medicine and Pain Management, Hospital Oldenburg, Oldenburg, Germany
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Randriamizao HMR, Rakotondrainibe A, Razafindrabekoto LDE, Ravoaviarivelo PF, Rajaonera AT, Andriamanarivo ML. Use of spinal anaesthesia in neonates and infants in Antananarivo, Madagascar: a retrospective descriptive study. BMC Res Notes 2020; 13:491. [PMID: 33087176 PMCID: PMC7579963 DOI: 10.1186/s13104-020-05330-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study was to present the first cases of spinal anesthesia, in newborns and infants, preterm/ex-prematures, in order to determine its feasibility and its potential harmlessness, in Antananarivo—Madagascar. Indeed, spinal anesthesia is a low cost technique and can limit respiratory complications, postoperative apnea a contrario with pediatric general anesthesia which can lead to perioperative risks. Results In a retrospective, descriptive, 7-year (2013 to 2019) period study, conducted in the University Hospital Joseph Ravoahangy Andrianavalona, 69 patients’ data files planned to have spinal anesthesia were recorded. These pediatric patients were predominantly male (sex ratio = 2.8) and 37 [28–52] days old. The smallest anesthetized child weighed 880 g; the youngest was 4 days old. Twenty-seven (27) of them were premature and 20.3% presented respiratory diseases. They were mostly scheduled for hernia repair (90%). Spinal anesthesia was performed, with a Gauge 25 Quincke spinal needle, after 2 [1–2] attempts with hyperbaric bupivacaine of 4 [3.5–4] mg. Failure rate was 5.8%. The heart rate was stable throughout perioperative period and no complications were observed.
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Affiliation(s)
| | - Aurélia Rakotondrainibe
- Department of Anesthesia and Intensive Care, University of Antananarivo, Antananarivo, Madagascar. .,Surgical Intensive Care, CHU Joseph Ravoahangy Andrianavalona, BP 4150 - 101, Antananarivo, Madagascar.
| | | | - Prisca F Ravoaviarivelo
- Department of Anesthesia and Intensive Care - Operating Theater, CHU Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | - Andriambelo T Rajaonera
- Department of Anesthesia and Intensive Care, University of Antananarivo, Antananarivo, Madagascar
| | - Mamy L Andriamanarivo
- Department of Pediatric Surgery, University of Antananarivo, Antananarivo, Madagascar
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15
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Starck C, Thierry S, Bernard CI, Morineau T, Jaulin F, Chapelain P, Komorowski M. Tracheal intubation in microgravity: a simulation study comparing direct laryngoscopy and videolaryngoscopy†. Br J Anaesth 2020; 125:e47-e53. [DOI: 10.1016/j.bja.2019.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022] Open
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16
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Hinkelbein J. Spaceflight: the final frontier for airway management? Br J Anaesth 2020; 125:e5-e6. [PMID: 31918846 DOI: 10.1016/j.bja.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; German Society of Aerospace Medicine (DGLRM), Munich, Germany; European Society of Aerospace Medicine (ESAM), Space Medicine Group, Cologne, Germany.
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17
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Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review. Prehosp Disaster Med 2019; 34:521-531. [PMID: 31462335 DOI: 10.1017/s1049023x19004734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Panesar SS, Fernandez-Miranda JC, Kliot M, Ashkan K. In Reply: Neurosurgery and Manned Spaceflight. Neurosurgery 2019; 85:E159-E160. [PMID: 31058971 DOI: 10.1093/neuros/nyz107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sandip S Panesar
- Department of Neurosurgery Stanford University Stanford, California
| | | | - Michel Kliot
- Department of Neurosurgery Stanford University Stanford, California
| | - Keyoumars Ashkan
- Department of Neurosurgery King's College Hospital London, United Kingdom
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Warnecke T, Tochtermann F, Kerkhoff S, Komorowski M, Neuhaus C, Hinkelbein J. Airway management in microgravity: A systematic review. Acta Anaesthesiol Scand 2019; 63:2-7. [PMID: 30203439 DOI: 10.1111/aas.13251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the near future, space programs will shift their focus toward long-duration interplanetary missions, in particular to the Moon and Mars. These exploration missions will be associated with an increased risk of acute medical problems, which will need to be handled by an autonomous crew operating in extreme isolation. An important skill in emergencies is represented by airway management. Many airway devices are available and it is unclear which one would be the most suitable in the context of a space mission. The aim of this systematic review was to analyze the existing literature on airway management in the special situation of weightlessness during space missions. MATERIAL AND METHODS We performed a standardized review of published literature on airway management in spaceflight and analogue environments using the database PubMed. RESULTS We identified a total of 3111 publications of which 3039 were initially excluded after evaluation. The screening identified three randomized comparative manikin studies, two of them in parabolic flights, one in a submerged setup. Under free-floating conditions, the insertion success rate of supraglottic airway devices (SGA) was excellent (91%-97%). The administration of artificial ventilation could be successfully achieved in weightlessness with SGA. The success rate of conventional laryngoscopy under free-floating conditions fluctuated between 15% and 86%. CONCLUSION It appears possible to safely manage the airway in weightlessness, provided that certain conditions are ensured, such as restraining the patient and operator for conventional orotracheal intubation. If airway protection is required with endotracheal intubation, both the operator and the patient should be restrained.
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Affiliation(s)
- Tobias Warnecke
- Department of Anesthesiology; Evangelisches Krankenhaus Duisburg; Duisburg Germany
| | | | - Steffen Kerkhoff
- Department of Anesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne Germany
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
| | - Matthieu Komorowski
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Christopher Neuhaus
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- Department of Anesthesiology; University Hospital of Heidelberg; Heidelberg Germany
| | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne Germany
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
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