Far away and beyond – Emergency medicine in the space environment

Monday 5 June, 16h00-17h30, Room Q

One of today’s sessions at Monday’s Euroanaesthesia covers the very unusual subject of medicine in the space environment.

The session will begin with a talk on ‘Considerations for the management of critical medical conditions during future space missions’ by Dr Matthieu Komorowski, Consultant in Intensive Care and Anaesthesia, Charing Cross Hospital, London, UK. Dr Komorowski currently acts as Visiting Scholar at the Laboratory of Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA, and was a former research fellow at the European Space Agency.

A number of agencies as well as private companies are planning manned missions to the Moon and Mars in coming years, and alongside these efforts, there are plans to begin space tourism; initially in the form of short sub-orbital flights, and later to Earth’s orbit and beyond.

As Dr Komorowski points out: “During these long duration flights, the estimated risk of severe medical and surgical events, as well as the risk of loss of crew life are significant.” He adds that: “The exposure to the space environment itself disturbs most physiological systems and can precipitate the onset of space-specific illnesses, such as cardiovascular deconditioning, acute radiation syndrome, hypobaric decompression sickness and osteoporotic fractures.”

The session will discuss the unique challenges that must be overcome in order to deliver both basic and advanced medical care in space, such as limited skills among the crew and strict payload limits which severely restrict the amount of medical equipment and consumables that can be carried. In the event of a crew member succumbing to illness or injury, they may have to be treated and cared for by personnel who lack formal medical training. If this situation occurs during a mission far beyond low Earth orbit, the transmission delays due to the large distances involved would make real-time telemedicine impossible, forcing the crew to be self-reliant.

Dr Komorowski notes that: “providing anaesthesia and organ support will prove very challenging, and a number of procedures and conditions may not be accessible to medical treatment.” His talk will cover various solutions and countermeasures that could be applied and discuss how they have been inspired by the needs of medical care in austere environments here on Earth.

The second talk will be delivered by Dr Jochen Hinkelbein, Senior Medical Officer for Emergency Medicine, Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Cologne, Germany.  Dr Hinkelbein has a particular interest in space anaesthesia, including the problems caused by the effects of space on the body and how it responds to anaesthetics, as well as the practical difficulties arising from limited crew training and equipment to perform anaesthesia.

Dr Hinkelbein will be discussing ‘Cardiopulmonary resuscitation (CPR) in microgravity’ and summarising the research conducted to determine the most effective techniques that can be used in a space environment.

Dr Hinkelbein, who is also President of the German Society for Aerospace Medicine (DGLRM), notes that: “Since astronauts are selected carefully, are usually young, and are intensively observed before and during their training, relevant medical problems are, fortunately, rare in space.” Despite this, he cautions that: “In the context of future long-term missions, e.g., to Mars, with durations of several years, the risk for severe medical problems is significantly higher. Therefore, there is also a certain risk for a cardiac arrest in space requiring CPR.”

Studies have already been performed into how emergency medical procedures could be implemented on a space mission. These have looked at therapeutic interventions including drawing blood, performing chest compressions for resuscitation, intubation, and anaesthesia. In order to perform these procedures, all astronauts receive basic medical instruction as part of their wider specialised technical training, with some crew members being trained to a much higher level to perform the role of Crew Medical Officer (CMO).

The nature of microgravity can make it difficult or impossible to successfully perform medical procedures in the same way that we would do so here on Earth. One such example of is how an individual providing CPR uses their body weight to perform the necessary compressions and would find this standard technique to be largely useless if they didn’t have gravity to assist them. The study considered five different CPR methods that could be used in space and compared their effectiveness to the quality parameters used in CPR guidelines in normal gravity. Tests were performed in short-duration microgravity on parabolic flights, or in simulated weightlessness in underwater test facilities. No research of this kind has yet been conducted in real space conditions.

It was found that the hand-stand (HS) technique was the most effective way to treat a cardiac arrest and most closely met the CPR guidelines for quality. In environments where this technique cannot be used, such as in confined spaces, the Evetts-Russomano method in which an astronaut wraps their legs around the patient to prevent them floating away, is a good alternative that is only slightly less effective than the ideal HS technique.

Dr Hinkelbein concludes that: “In the context of future space exploration, the longer duration of missions, and the consecutively higher risk of an incident requiring resuscitation increase the importance of microgravity-appropriate medical techniques.”