1. CPR in Space Prof. Mirjana Shosholcheva
Department of Anaesthesia and Intensive Care
Faculty of Medicine-Skopje, Macedonia

2. "Imagine, for a moment, trying to deliver cardiac compressions while floating weightlessly in orbit,"
How do astronauts perform life saving
treatment in zero gravity?
And were are right to think it must be complicated!

3. Key points An astronaut in microgravity could suffer a cardiac arrest
and need immediate cardiopulmonary resuscitation
Traumatic causes may cause a cardiac arrest
The spectrum of therapeutic interventions ranges from the
initiation of chest compressions for resuscitation,
to intubation

4. CPR (Cardio pulmonary resuscitation)
a well-known emergency procedure here on Earth, administered to someone whose heart has stopped beating.
Chest compressions of at least 5 cm deep are given at a rate of 100 per minute to try and manually pump blood through the heart and body
Not too difficult to perform on Earth but what happens in the microgravity of Space?

5. On Earth we use the weight of our bodies to make the compressions – but in space our body weights nothing!
To be more precise, what we think of as our weight, is actually the force with which our body is attracted towards the Earth.
When we are in space we do not feel gravitational attraction to the Earth and so effectively, we are weightless.
Therefore, giving chest compressions depends more on the force and strength of the arms of the person providing the CPR

6. Body suspension device with mannequin fully suspended simulated microgravity

7. All astronauts receive a basic level of medical training as
part of their specialized astronaut technical training

10. In the context of future space exploration (e. g
In the context of future space exploration (e.g., a mission to Mars), the longer duration of missions and consecutively higher risk
of an incident requiring resuscitation, increase the importance
of microgravity-appropriate medical techniques

11. Everything is floating - including you and the person who need
Adequate cardio-pulmonary resuscitation techniques in space (microgravity and weightlessness Main problem:
Everything is floating - including
you and the person who need
assistance!
Lack of gravity
Attempting compressions of the chest in microgravity onlyleads to pushing away from each other, without achieving a haemodynamically significant cardiac output (CO) in the patient.
If you try to compress the chest as you do on Earth, the force you apply will generate a reaction force in the opposite direction (Newton’s Laws of Motion) – simply put, you will float away from the person you are trying to help!

12. There are five described methods that deal with
the solution of this problem

13. Techniques “Standard side straddle (STD) method”
“Waist Straddling maneuver (SM)”
“Reverse Bear Hug (RBH) method”
“Evetts-Russomano (ER) method”
“Handstand (HS) method”

14. Standard side straddle (STD) method
The rescuer places him sideways and
the patient is situated on the crew medical restraint system for CPR.

15. Waist Straddling manoeuvre (SM)
The rescuer straddled the patient’s
waist, with the patient situated on the crew medical restraint system for CPR.

16. Reverse Bear Hug (RBH) method
The rescuer grips the patient from the
back with both arms and performs compressions

17. Evetts-Russomano (ER) method
In the ER method, the rescuer places
himself on top of the patient. He places his left leg over the right shoulder of the patient. The right leg of the rescuer is placed around the patient’s
back under the left arm.
The chest compression applied against the sternum is countered by the force exerted by the rescuers’s crossed legs.

18. Evetts-Russomano (ER) method

19. Handstand (HS) method
To carry out the HS method, the rescuer places his feet on one wall of the cabin, with the patient’s back against the opposite wall, and the chest compressions are applied against the sternum

20. The HS method is superior in both the pure compression depth
Handstand (HS) method
The HS method is superior in both the pure compression depth
However, this technique requires a specific setting (wall-to-wall distance below 2. 5m) not being present at every location in space. In such a case, the ER technique is a reasonable alternative

21. What does this mean for future space missions?
It is unlikely that BLS can be carried out with the same performance in space as on earth
Even under ideal conditions not every CPR is able to achieve a return of spontaneous circulacion

22. Defibrillators in space
When a shock is being applied in a regular operating theatre, no one can touch the patient because of the powerful electromagnetic current
But in space?

23. – if you need to defibrillate [or shock] the patient
In space, the application of a defibrillator is not so much a problem – it’s the electric current that poses an obstacle: :
In space, other crew members are floating around
and astronaut chairs could be conductive
– if you need to defibrillate
[or shock] the patient
the question is how do you do it
without shocking everybody else
around you?’
Special defibrillators have to be used, so they don’t interfere
with the electronics of the space station

24. NASA announced in 2008 the Lifepak 1000
defibrillator as being deployed on the International
Space Station (ISS) as the first automated
external defibrillator (AED) in space
Evaluations of the defibrillators included:
- user interface analysis
ease of use
durability and detailed technical specifications related to the unique conditions encountered in space
Analysis and testing for electromagnetic interference, pressure susceptibility, temperature, vibration, acceleration and other environmental factors

25. with drugs and adrenaline into the patient's vein
Management with drugs
Make syringes bubble-free
You need to account for how liquids move in space?
On Earth, bubbles float to the surface, but in space they spread themselves through the liquid, because of lack of gravity
The astronauts have to adapt the way they insert and deliver drips
with drugs and adrenaline into the patient's vein
The thing you need to have is bubble filters for your syringe
Without filters, you deal with an emulsion of bubbles suspended in the solution, and you'd just be injecting air

26. Come back to the Earth!
Once you've got the patient's circulation going, he is still going to need intensive care, including ventilators and drugs that promote circulation
According to facts, the International Space Stations have less medical equipment and expertise than an average ambulance
So you need to get the victim home as quickly as possible, which is tricky

28. An illustration of the Mars MAVEN spacecraft, which launched in fall 2013