non-terrestrial basic life support simon n evetts phd
DESCRIPTION
Non-terrestrial Basic Life Support Simon N Evetts PhD. CPR in Microgravity Simon N Evetts PhD. Thais Russomano MD PhD John Ernsting MBBS PhD Subhajit Sarkar MRCS Lisa Evetts RGN Jo ã o Castro MD Microgravity Laboratory, PUCRS, Porto Alegre, Brazil. - PowerPoint PPT PresentationTRANSCRIPT
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 MicrogravitySimon N Evetts PhD
Non-terrestrial Basic Life SupportSimon N Evetts PhD
Introduction Non-terrestrial as opposed to microgravity.
Introduction Non-terrestrial as opposed to microgravity.
Basic Life Support;
Introduction Non-terrestrial as opposed to microgravity.
Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
Introduction Non-terrestrial as opposed to microgravity.
Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
Introduction Non-terrestrial as opposed to microgravity.
Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
Single rescuer, not multiple care-giver.
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 Space exploration is inherently dangerous.
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
Significant Space Related Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
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 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 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 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 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 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 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 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 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)
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)
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
Earth Gravity (9.8 ms-2)
7.0
6.1
4.1
0
100
200
300
400
500
600
700
800
900
1000
0 1 2 3 4 5 6 7 8 9 10 11
Compression depth (cm)
Fo
rce
(N)
Minimum required depth (3.8 cm)
Mean β +1 s.d.,
γ +1 s.d.
β +2 s.d.,
γ +2 s.d.β -1 s.d.,
γ -1 s.d.
β -2 s.d.,
γ -2 s.d.
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
For
ce (
N)
Compression Depth (cm)
Average compliance chest
Earth Gravity
9.8 m.s-1
+0.16 Gz - The Moon
+0.16 Gz - The Moon
Lunar Gravity (1.62 ms-2)
1.0
2.01.7
0
100
200
300
400
500
600
700
800
900
1000
0 1 2 3 4 5 6 7 8 9 10 11
Compression depth (cm)
Fo
rce (
N)
β +1 s.d., γ +1 s.d.
β +2 s.d., γ +2 s.d.
β -1 s.d., γ -1 s.d.
β -2 s.d., γ -2 s.d.
Mean
Minimum required depth (3.8 cm) 93 kg
76 kg41 kg
Lunar Gravity
Compression Depth (cm)
For
ce (
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 - MarsSpaceman 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
Mars Gravity (3.71 ms-2)
3.73.2
2.0
0
100
200
300
400
500
600
700
800
900
1000
0 1 2 3 4 5 6 7 8 9 10 11
Compression depth (cm)
Fo
rce (
N)
Minimum required depth
β +1 s.d., γ +1 s.d. Mean
β +2 s.d., γ +2 s.d.
β -1 s.d., γ -1 s.d..
β -2 s.d., γ -2 s.d..
93 kg76 kg
41 kg
Mars Gravity
Compression Depth (cm)
For
ce (
N)
Chest Compression Depth According to Rescuer Body Weight
Small patient/high compliance chest
Average compliance chest
76 kg provider - Mean compliance chest - Different gravities
1.7
3.2
6.1
0
100
200
300
400
500
600
700
800
900
1000
0 1 2 3 4 5 6 7 8 9 10 11
Compression depth (cm)
Fo
rce
(N
)
Minimum required depth (3.8 cm)
On Earth
On Mars
On Moon
Compression Depth (cm)
For
ce (
N)
Mean Mass Rescuer – Mean Chest Compliance Patient
76 kg Rescuer
What can be done about off planet BLS?
Assisted CPR.– Using a restraint system.
Assisted CPR.– Using a restraint system.
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?
Assisted CPR.– Using a restraint system.– Using assistance devices.– Multiple person CPR.
What can be done about off planet BLS?
Technique of compression
Equipment Description
Standard Nil Normal terrestrial CPR method.
Heimlich CPR Method
Nil Rescuer behind patient, chest compression by elbow flexion.
Abdominal compression
Nil Abdomen compressed to utilize pure abdominal pump mechanism.
Mass momentum method
Nil Dropping from a height provides potential energy. The force may be applied by the hands or the feet.
What can be done about off planet BLS?
Technique of compression
Equipment Description
Standard Nil Normal terrestrial CPR method.
Heimlich CPR Method
Nil Rescuer behind patient, chest compression by elbow flexion.
Abdominal compression
Nil Abdomen compressed to utilize pure abdominal pump mechanism.
Mass momentum method
Nil Dropping from a height provides potential energy. The force may be applied by the hands or the feet.
What can be done about off planet BLS?
Technique of compression
Equipment Description
Standard Nil Normal terrestrial CPR method.
Heimlich CPR Method(RBH)
Nil Rescuer behind patient, chest compression by elbow flexion.
Abdominal compression
Nil Abdomen compressed to utilize pure abdominal pump mechanism.
Mass momentum method
Nil Dropping from a height provides potential energy. The force may be applied by the hands or the feet.
What can be done about off planet BLS?
Technique of compression
Equipment Description
Standard Nil Normal terrestrial CPR method.
Heimlich CPR Method
Nil Rescuer behind patient, chest compression by elbow flexion.
Abdominal compression
Nil Abdomen compressed to utilize pure abdominal pump mechanism.
Mass momentum method
Nil Dropping from a height provides potential energy. The force may be applied by the hands or the feet.
What can be done about off planet BLS?
Technique of compression
Equipment Description
Standard Nil Normal terrestrial CPR method.
Heimlich CPR Method
Nil Rescuer behind patient, chest compression by elbow flexion.
Abdominal compression
Nil Abdomen compressed to utilize pure abdominal pump mechanism.
Mass momentum method
Nil Dropping from a height provides potential energy. The force may be applied by the hands or the feet.
What can be done about off planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs to enable additional force application through hip/knee flexion.
Added mass Weights Standard method with added masses (e.g. on a weight belt).
Assist device Elastic compression assist device
Large ‘elastic band’ placed around the patient’s back and over the rescuer’s shoulders/back provides additional force.
Modified Hand-stand Method (HS)
Opposing ‘walls’ approx 2m apart.
Modification of the microgravity hand-stand method.
What can be done about off planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs to enable additional force application through hip/knee flexion
Added mass Weights Standard method with added masses (e.g. on a weight belt).
Assist device Elastic compression assist device
Large ‘elastic band’ placed around the patient’s back and over the rescuer’s shoulders/back provides additional force.
Modified Hand-stand Method (HS)
Opposing ‘walls’ approx 2m apart.
Modification of the microgravity hand-stand method.
What can be done about off planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs to enable additional force application through hip/knee flexion
Added mass Weights Standard method with added masses (e.g. on a weight belt).
Assist device Elastic compression assist device
Large ‘elastic band’ placed around the patient’s back and over the rescuer’s shoulders/back provides additional force.
Modified Hand-stand Method (HS)
Opposing ‘walls’ approx 2m apart.
Modification of the microgravity hand-stand method.
What can be done about off planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs to enable additional force application through hip/knee flexion
Added mass Weights Standard method with added masses (e.g. on a weight belt).
Assist device Elastic compression assist device
Large ‘elastic band’ placed around the patient’s back and over the rescuer’s shoulders/back provides additional force.
Modified Hand-stand Method (HS)
Opposing ‘walls’ approx 2m apart.
Modification of the microgravity hand-stand method.
What can be done about off planet BLS?
N.B.
• A major limitation of all microgravity BLS methods is the lack of back/neck/head support!
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
Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet?
(Fly before we bound)
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
Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet?
Current unrestrained Basic Life Support methods.– Hand stand method
Hand Stand method
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).
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
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
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.
Manikin trials.
Manikin trials.
Manikin trials.
Results
Measure +1GZ MicrogravityChest Compressions Depth (mm) 43.6 ± 0.59 41.3 ± 1.03 Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2 Rate (compressions.min-1) 97.1 ± 3.0 80.2 ± 3.4 Percent correct (depth) 90% 60% n 225 672Tidal Volume Volume (ml) 507.6 ± 11.5 491 ± 50.4 Range (min-max, ml) 423 – 570 284 - 891 Percent correct 87% 69% n 30 32
Results
Measure +1GZ MicrogravityChest Compressions Depth (mm) 43.6 ± 0.59 41.3 ± 1.03 Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2 Rate (compressions.min-1) 97.1 ± 3.0 80.2 ± 3.4 Percent correct (depth) 90% 60% n 225 672Tidal Volume Volume (ml) 507.6 ± 11.5 491 ± 50.4 Range (min-max, ml) 423 – 570 284 - 891 Percent correct 87% 69% n 30 32
Results
Measure +1GZ MicrogravityChest Compressions Depth (mm) 43.6 ± 0.59 41.3 ± 1.03 Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2 Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 * Percent correct (depth) 90% 60% n 225 672Tidal Volume Volume (ml) 507.6 ± 11.5 491 ± 50.4 Range (min-max, ml) 423 – 570 284 - 891 Percent correct 87% 69% n 30 32
* P < 0.05
Results
Measure +1GZ MicrogravityChest Compressions Depth (mm) 43.6 ± 0.59 41.3 ± 1.03 Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2 Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 * Percent correct (depth) 90% 60% n 225 672Tidal Volume Volume (ml) 507.6 ± 11.5 491 ± 50.4 Range (min-max, ml) 423 – 570 284 - 891 Percent correct 87% 69% n 30 32
Results
Measure +1GZ MicrogravityChest Compressions Depth (mm) 43.6 ± 0.59 41.3 ± 1.03 Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2 Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 * Percent correct (depth) 90% 60% n 225 672Tidal Volume Volume (ml) 507.6 ± 11.5 491 ± 50.4 Range (min-max, ml) 423 – 570 284 - 891 Percent correct 87% 69% n 30 32
Discussion
Reasons for insufficient rate of chest compression and greater variation of measures in microgravity.
Discussion
Reasons for insufficient rate of chest compression and greater variation of measures in microgravity.– Novelty of environment.
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
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).
ER compared to other methods of performing CPR in microgravity.
Discussion
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
• 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
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
Discussion
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
Discussion
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
Discussion
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
Discussion
Measure ER Hand Stand
Rev Bear Hug
ERC 98 Guidelines
Chest Comp Depth (mm)
41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64
40 – 50
Chest Comp Rate (per min)
80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1
~ 100
Tidal Volume (ml)
491 ± 50.4 - - 400 - 600
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
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
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
Non-terrestrial CPR - will one size fit all?
Conclusion
Non-terrestrial CPR - will one size fit all?– Off planet (no artificial gravity).
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
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
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
Non-terrestrial CPR - will one size fit all?– Off planet (no artificial gravity).– On planet (within habitat).
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 ?
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
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.
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.
Train in multiple CPR techniques?
Conclusion
Conventional CPR
Assisted methodsER CPR HS CPR
Train in multiple CPR techniques? Mission oriented training.
Conclusion
Conventional CPR
Assisted methodsER CPR HS CPR
Train in multiple CPR techniques? Mission oriented training.
– CPR techniques appropriate for habitat and risks according to mission tasks.
Conclusion
Conventional CPR
Assisted methodsER CPR HS CPR
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 methodsER CPR HS CPR
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