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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2020 | Cardiopulmonary Resuscitation | Guideline

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)

Authors: Jochen Hinkelbein, Steffen Kerkhoff, Christoph Adler, Anton Ahlbäck, Stefan Braunecker, Daniel Burgard, Fabrizio Cirillo, Edoardo De Robertis, Eckard Glaser, Theresa K. Haidl, Pete Hodkinson, Ivan Zefiro Iovino, Stefanie Jansen, Kolaparambil Varghese Lydia Johnson, Saskia Jünger, Matthieu Komorowski, Marion Leary, Christina Mackaill, Alexander Nagrebetsky, Christopher Neuhaus, Lucas Rehnberg, Giovanni Marco Romano, Thais Russomano, Jan Schmitz, Oliver Spelten, Clément Starck, Seamus Thierry, Rochelle Velho, Tobias Warnecke

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2020

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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Title: 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)
Authors: Jochen Hinkelbein
Steffen Kerkhoff
Christoph Adler
Anton Ahlbäck
Stefan Braunecker
Daniel Burgard
Fabrizio Cirillo
Edoardo De Robertis
Eckard Glaser
Theresa K. Haidl
Pete Hodkinson
Ivan Zefiro Iovino
Stefanie Jansen
Kolaparambil Varghese Lydia Johnson
Saskia Jünger
Matthieu Komorowski
Marion Leary
Christina Mackaill
Alexander Nagrebetsky
Christopher Neuhaus
Lucas Rehnberg
Giovanni Marco Romano
Thais Russomano
Jan Schmitz
Oliver Spelten
Clément Starck
Seamus Thierry
Rochelle Velho
Tobias Warnecke
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Cardiopulmonary Resuscitation
Airway Management
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2020
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-020-00793-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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)

Abstract

Background

Methods

Results

Discussion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Discussion

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