Extraterrestrial CPR and Its Applications in Terrestrial Medicine

Abstract

Cardiopulmonary resuscitation (CPR) is a well-established part of basic life support (BLS), saving countless lives since its first development in the 1960s. Recently, work has been undertaken to develop methods of basic and advanced life support (ALS) in microgravity and hypogravity. Although the likelihood of a dangerous cardiac event occurring during space mission is rare, the possibility exists. The selection process for space missions nowadays considers individuals at ages and with health standards that would have precluded their selection in the past. The advent of space tourism may even enhance this possibility. This chapter presents a synthesis of the results obtained in studies conducted at the MicroG-PUCRS, Brazil, examining extraterrestrial CPR during ground-based microgravity and hypogravity simulations and during parabolic flights and sustained microgravity. It outlines the extraterrestrial BLS guidelines for both low-orbit and deepspace missions. The former are based on a combination of factors, unique for the environment of space. In a setting like this, increased physiological stress due to gravitational adaptation and the isolated nature of the environmental demands can affect the outcome of resuscitation procedure.

Cardiac arrest during space missions: Specificities and challenges

“…One of the key issues is the implementation of adequate CPR techniques. While CPR under normal (earth) conditions is very well examined and established, various difficulties arise from its application in weightlessness or reduced gravity [35], the…”

“…Due to the impossibility of conducting CPR studies in-situ in space, parabolic flights and ground-based simulations, such as those using a BSD, have been used to fully comprehend the efficacy and benefits of the most common extraterrestrial CPR methods [35]. These simulations, however, come with their own limitations related to the volunteer and CPR dummy used, and these must be understood to allow proper conclusions to be drawn regarding the application of different CPR techniques in space.…”

“…This device is unable to reproduce the alteration in chest shape that occurs in reduced gravity environments, with the chest becoming more rounded, increasing the distance between rib cage and the heart, which in turn can affect the ideal chest compression depth for a successful CPR. The CPR dummy is unable to replicate the physiological effects on the cardiopulmonary system seen during actual microgravity or hypogravity exposure, which also potentially have an effect on CPR performance and/or outcome [35].…”

Kardiopulmonale Reanimation im Weltall

“…Auch wenn das Risiko für ernsthafte medizinische Probleme im All gering ist [3], alle Raumfahrer medizinisch engmaschig und gut untersucht werden, besteht nichtsdestotrotz die Möglichkeit, dass ein Astronaut in Schwerelosigkeit einen Kreislaufstillstand erleidet und reanimiert werden muss [14]. Dieses Risiko begründet sich auch nicht ausschließlich auf (patho)physiologische Änderungen und Vorerkrankungen, sondern wird auch durch unerwartet auftretende Ereignisse (z.…”

“…Während die kardiopulmonale Reanimation unter normalen Schwerkraftbedingungen (also auf der Erde = 1G) sehr gut untersucht und die Technik weit verbreitet und vergleichsweise einheitlich praktiziert wird, entstehen in der reinen Umsetzung der bekannten Technik unter Schwerelosigkeit relevante Probleme [14]. Vor allem bei der Durchführung von Thoraxkompressionen die fehlende Gravitation durch eine mangelnde Gegenkraft einen limitierenden Faktor dar, eine suffizienten kardialen Auswurf oder ein Return Of Spontaneous Circulation (ROSC) zu erreichen [15].…”