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Published on October 26, 2007

Author: Sharck

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Non-terrestrial Basic Life Support Simon N Evetts PhD:  Thais Russomano MD PhD John Ernsting MBBS PhD Subhajit Sarkar MRCS Lisa Evetts RGN João Castro MD Microgravity Laboratory, PUCRS, Porto Alegre, Brazil. Human Physiology and Aerospace Medicine Group, King’s College London. CPR in Microgravity Simon N Evetts PhD Non-terrestrial Basic Life Support Simon N Evetts PhD Introduction:  Introduction Non-terrestrial as opposed to microgravity. Introduction:  Introduction Non-terrestrial as opposed to microgravity. Basic Life Support; Introduction:  Introduction Non-terrestrial as opposed to microgravity. Basic Life Support; Cardiopulmonary Resuscitation without equipment or other resources. Introduction:  Introduction Non-terrestrial as opposed to microgravity. Basic Life Support; Cardiopulmonary Resuscitation without equipment or other resources. Introduction:  Introduction Non-terrestrial as opposed to microgravity. Basic Life Support; Cardiopulmonary Resuscitation without equipment or other resources. Single rescuer, not multiple care-giver. Introduction:  Introduction Non-terrestrial as opposed to microgravity. Basic Life Support; Cardiopulmonary Resuscitation without equipment or other resources. Single rescuer, not multiple care-giver. Emphasis on chest compression, mouth-to-mouth ventilation secondary consideration. The Space Environment:  The Space Environment Space exploration is inherently dangerous. Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Significant Space Related Medical Occurrences:  Significant Space Related Medical Occurrences Pulseless victim:  Pulseless victim The Space Medicine Configuration Control Board of NASA has approved a list of 442 medical conditions (the Patient Condition Database) that appear possible during long duration spaceflight on the ISS. Pulseless victim:  Pulseless victim The Space Medicine Configuration Control Board of NASA has approved a list of 442 medical conditions (the Patient Condition Database) that appear possible during long duration spaceflight on the ISS. Of these conditions 106 (24 %) are classified as “critical” requiring use of critical care procedures. Pulseless victim:  Pulseless victim The Space Medicine Configuration Control Board of NASA has approved a list of 442 medical conditions (the Patient Condition Database) that appear possible during long duration spaceflight on the ISS. Of these conditions 106 (24 %) are classified as “critical” requiring use of critical care procedures. …including cardiac conditions (e.g. myocardial infarction, ventricular fibrillation, ventricular tachycardia, and asystole), Pulseless victim:  Pulseless victim The Space Medicine Configuration Control Board of NASA has approved a list of 442 medical conditions (the Patient Condition Database) that appear possible during long duration spaceflight on the ISS. Of these conditions 106 (24 %) are classified as “critical” requiring use of critical care procedures. …including cardiac conditions (e.g. myocardial infarction, ventricular fibrillation, ventricular tachycardia, and asystole), …and respiratory conditions (e.g. acute airway obstruction, laryngeal oedema from anaphylaxis and inhalation injuries). Pulseless victim:  Pulseless victim It has been estimated that the risk to an ISS crew member of developing a serious medical condition requiring medical evacuation is 6% per year*, * Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific Meeting of the Aerospace Medical Association, Houston, Texas. May 2000. Pulseless victim:  Pulseless victim It has been estimated that the risk to an ISS crew member of developing a serious medical condition requiring medical evacuation is 6% per year*, … and 1% per year risk of a life-threatening condition*. * Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific Meeting of the Aerospace Medical Association, Houston, Texas. May 2000. Pulseless victim:  Pulseless victim It has been estimated that the risk to an ISS crew member of developing a serious medical condition requiring medical evacuation is 6% per year*, … and 1% per year risk of a life-threatening condition*. A figure of 0.15%/yr of CAD related event occurring in 35-45 yr old flight personnel has been cited**. * Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific Meeting of the Aerospace Medical Association, Houston, Texas. May 2000. ** Ball, C.G., Hamilton, D.R. and Kirkpatrick, A. 2004. Primary prevention approach to mitigating cardiac risk in astronauts. 75th Annual Scientific Meeting of the Aerospace Medical Association, Houston, Anchorage. May 2004. Pulseless victim:  Pulseless victim As has the figure of 0.06 persons/year with regards to the risk of a healthy astronaut receiving a significant injury or developing a significant medical condition in space*. * Mukai, C. and Charles, J. B. 2004. Psychological and medical challenges for Mars crew composition as considered against similar challenges faced by the Lewis and Clark Expedition. 75th Annual Scientific Meeting of the Aerospace Medical Association, Houston, Anchorage. May 2004. Pulseless victim:  Pulseless victim As has the figure of 0.06 persons/year with regards to the risk of a healthy astronaut receiving a significant injury or developing a significant medical condition in space*. The potential for a serious medical incident resulting in a pulseless apneic state requiring intervention, therefore is real. * Mukai, C. and Charles, J. B. 2004. Psychological and medical challenges for Mars crew composition as considered against similar challenges faced by the Lewis and Clark Expedition. 75th Annual Scientific Meeting of the Aerospace Medical Association, Houston, Anchorage. May 2004. Recent and current CPR guidelines (+1Gz):  Recent and current CPR guidelines (+1Gz) European Resuscitation Council 1998: Mouth-to-mouth ventilation requiring tidal volumes of 400 – 600 ml. Chest compression depth of 40 – 50 mm. Chest compression rate of ~ 100 compressions.min-1. Recent and current CPR guidelines (+1Gz):  Recent and current CPR guidelines (+1Gz) European Resuscitation Council 1998: Mouth-to-mouth ventilation requiring tidal volumes of 400 – 600 ml. Chest compression depth of 40 – 50 mm. Chest compression rate of ~ 100 compressions.min-1. European Resuscitation Council 2001: Tidal volumes of 700 – 1000 ml. Chest compression depth of 40 – 50 mm. Chest compression rate in excess of 100 min-1. +1Gz - Earth:  +1Gz - Earth Chest Compression Depth According to Rescuer Body Weight:  93 kg person 76 kg person Chest Compression Depth According to Rescuer Body Weight Min required depth Big patient/low compliance chest Small patient/high compliance chest 41 kg person Force (N) Compression Depth (cm) Average compliance chest Earth Gravity 9.8 m.s-1 +0.16 Gz - The Moon:  +0.16 Gz - The Moon +0.16 Gz - The Moon:  +0.16 Gz - The Moon Chest Compression Depth According to Rescuer Body Weight:  93 kg 76 kg 41 kg Lunar Gravity Compression Depth (cm) Force (N) Average compliance chest Chest Compression Depth According to Rescuer Body Weight Small patient/high compliance chest +0.38 Gz - Mars:  +0.38 Gz - Mars +0.38 Gz - Mars:  +0.38 Gz - Mars +0.38 Gz - Mars:  +0.38 Gz - Mars Spaceman Spiff wrestles with his Galactic Mk 3 Mars Lander, but what with muscle wastage, deconditioning and Martian death rays, the landing wasn’t looking too good!! +0.38 Gz - Mars:  +0.38 Gz - Mars Chest Compression Depth According to Rescuer Body Weight:  93 kg 76 kg 41 kg Mars Gravity Compression Depth (cm) Force (N) Chest Compression Depth According to Rescuer Body Weight Small patient/high compliance chest Average compliance chest Mean Mass Rescuer – Mean Chest Compliance Patient:  On Earth On Mars On Moon Compression Depth (cm) Force (N) Mean Mass Rescuer – Mean Chest Compliance Patient 76 kg Rescuer What can be done about off planet BLS?:  What can be done about off planet BLS? Assisted CPR. Using a restraint system. What can be done about off planet BLS?:  Assisted CPR. Using a restraint system. What can be done about off planet BLS? What can be done about off planet BLS?:  Assisted CPR. Using a restraint system. Using assistance devices. What can be done about off planet BLS? What can be done about off planet BLS?:  Assisted CPR. Using a restraint system. Using assistance devices. Multiple person CPR. What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? What can be done about off planet BLS?:  What can be done about off planet BLS? N.B.:  N.B. A major limitation of all microgravity BLS methods is the lack of back/neck/head support! N.B.:  N.B. A major limitation of all microgravity BLS methods is the lack of back/neck/head support! A decision will need to be made as whether a potential back/neck injury poses a greater risk than not receiving adequate CPR. Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? (Fly before we bound) Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? Current unrestrained Basic Life Support methods. Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? Current unrestrained Basic Life Support methods. Hand stand method Hand Stand method:  Hand Stand method Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? Current unrestrained Basic Life Support methods. Hand stand method Reverse bear-hug (Heimlich). Reverse Bear-hug (Modified Heimlich).:  Reverse Bear-hug (Modified Heimlich). Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? Current unrestrained Basic Life Support methods. Hand stand method Reverse bear-hug (Heimlich). Limitations. Lets Walk Before We Can Run:  Lets Walk Before We Can Run Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? Current unrestrained Basic Life Support methods. Hand stand method Reverse bear-hug (Heimlich). Limitations. Can a method of CPR (with fewer limitations than current methods) be performed by anyone, anywhere when off planet? King’s/PUCRS CPR in Microgravity Study:  King’s/PUCRS CPR in Microgravity Study ER CPR method – chest compression potential.:  ER CPR method – chest compression potential. ER CPR method – chest compression potential.:  ER CPR method – chest compression potential. ER CPR method – chest compression potential.:  ER CPR method – chest compression potential. ER CPR method – chest compression potential.:  ER CPR method – chest compression potential. ER method – ventilation potential.:  ER method – ventilation potential. ER method – ventilation potential.:  ER method – ventilation potential. Manikin trials.:  Manikin trials. Manikin trials.:  Manikin trials. Manikin trials.:  Manikin trials. Results:  Results Results:  Results Results:  Results * P < 0.05 Results :  Results Results :  Results Discussion:  Discussion Reasons for insufficient rate of chest compression and greater variation of measures in microgravity. Discussion:  Discussion Reasons for insufficient rate of chest compression and greater variation of measures in microgravity. Novelty of environment. Discussion:  Discussion Reasons for insufficient rate of chest compression and greater variation of measures in microgravity. Novelty of environment. Variable acceleration forces and shortness of microgravity exposure. Discussion:  Discussion Reasons for insufficient rate of chest compression and greater variation of measures in microgravity. Novelty of environment. Variable acceleration forces and shortness of microgravity exposure. Use of +1Gz manikin (albeit adapted for microgravity use). Discussion:  ER compared to other methods of performing CPR in microgravity. Discussion Discussion:  Jay, Lee, Goldsmith, Battat, Maurer and Suner, 2003. CPR effectiveness in microgravity: Comparisons of thee positions and a mechanical device. Aviat Space Environ Med, 74(11): 1183-9 Discussion Discussion:  Discussion Discussion:  Discussion Discussion:  Discussion Discussion:  Discussion Discussion:  Effectiveness of the ER method for all populations will need to be ascertained before it can be considered a viable method for universal use. Discussion Discussion:  Effectiveness of the ER method for all populations will need to be ascertained before it can be considered a viable method for universal use. Discussion Strength Anthropometric indices Cardiovascular fitness Discussion:  Effectiveness of the ER method for all populations will need to be ascertained before it can be considered a viable method for universal use. Strength Anthropometric indices Cardiovascular fitness Indications are that ER CPR should be possible for almost anyone, anywhere off planet. Discussion Conclusion:  Non-terrestrial CPR - will one size fit all? Conclusion Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). Conclusion Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). Large habitat, no immediate access to equipment and requirement to conduct CPR for mins not secs. Conclusion ER CPR Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). Large habitat, no immediate access to equipment and requirement to conduct CPR for mins not secs. Conclusion ER CPR Large habitat, access to appropriate equipment e.g. CPR assist band, compression assist device. Assisted methods Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). Large habitat, no immediate access to equipment and requirement to conduct CPR for mins not secs. Conclusion ER CPR Small habitat, no immediate access to equipment and requirement to conduct CPR for hours not mins. HS CPR Large habitat, access to appropriate equipment e.g. CPR assist band, compression assist device. Assisted methods Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). On planet (within habitat). Conclusion Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). On planet (within habitat). Gravity greater than +0.5Gz. Conclusion Conventional CPR ? Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). On planet (within habitat). Gravity greater than +0.5Gz. Conclusion Conventional CPR ? Gravity less than +0.5Gz, large habitat, no immediate access to equipment. ER CPR Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). On planet (within habitat). Gravity greater than +0.5Gz. Conclusion Conventional CPR ? Gravity less than +0.5Gz, large habitat, no immediate access to equipment. Assisted methods ER CPR Gravity less than +0.5Gz, large habitat, access to appropriate equipment. Conclusion:  Non-terrestrial CPR - will one size fit all? Off planet (no artificial gravity). On planet (within habitat). Gravity greater than +0.5Gz. Conclusion Conventional CPR ? Gravity less than +0.5Gz, small habitat, no immediate access to equipment, CPR required for hours not mins. Gravity less than +0.5Gz, large habitat, no immediate access to equipment. Assisted methods ER CPR HS CPR Gravity less than +0.5Gz, large habitat, access to appropriate equipment. Conclusion:  Train in multiple CPR techniques? Conclusion Conventional CPR Assisted methods ER CPR HS CPR Conclusion:  Train in multiple CPR techniques? Mission oriented training. Conclusion Conventional CPR Assisted methods ER CPR HS CPR Conclusion:  Train in multiple CPR techniques? Mission oriented training. CPR techniques appropriate for habitat and risks according to mission tasks. Conclusion Conventional CPR Assisted methods ER CPR HS CPR Conclusion:  Train in multiple CPR techniques? Mission oriented training. CPR techniques appropriate for habitat and risks according to mission tasks. Foreseeable future will probably require 1 or 2 methods to be learnt for each mission. Conclusion Conventional CPR Assisted methods ER CPR HS CPR Thank you for your time Any questions?:  Thank you for your time Any questions? Slide104:  E-mail address simon.n.evetts@kcl.ac.uk

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