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.
Highlights
Space exploration and discovery will take humans far beyond low-Earth orbit (LEO).The National Aeronautics and Space Administration (NASA) and the European SpaceAgency (ESA) are preparing to send astronauts to the Moon (Artemis mission) to help prepare humanity for its step—sending astronauts to Mars [1]
(RCT) comparing comparing two two new new methods methods in a free-floating underwater setting. Both methods require the operator to stabistabifor cardiopulmonary resuscitation (CPR) in a free-floating underwater setting. Both methods require the operator to lize the patient on his/her his/her thighs and deliver chest compressions using both arms in the the thethe patient on his/her thighs andand deliver chest compressions using both arms in the first lize patient on thighs deliver chest compressions using both arms in first method
The Schmitz–Hinkelbein method showed overall superior results for compression rate and compression depth associated with low rates of no-flow time and high rates of correct thoracic release in comparison to the second new method (CM)
Summary
Space exploration and discovery will take humans far beyond low-Earth orbit (LEO).The National Aeronautics and Space Administration (NASA) and the European SpaceAgency (ESA) are preparing to send astronauts to the Moon (Artemis mission) to help prepare humanity for its step—sending astronauts to Mars [1]. The journey will take up to 9 months each way causing extreme isolation and, resulting in total crew autonomy for almost 3 years [2,3] During both Moon and Mars missions, there will be no possibility for crews to rapidly return to the ground in cases of an emergency; real-time assistance from Earth will be limited or impossible due to communication delays [4,5]. 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).
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