Wednesday, May 13, 2015

CPR in space is possible, maybe

Last summer I wrote about the many problems associated with performing surgery in outer space. [Link here.]  Not surprisingly, I was highly skeptical about such issues as training astronauts to operate on each other and the difficulties in taking along enough supplies to deal with unexpected trauma and surgical diseases.

At least one commentor on that post felt that NASA had all the answers. But another said, “What NASA never wants to discuss publicly is the scenario: If X happens then you die.”

Not to be outdone, the European Space Agency recently released a YouTube video illustrating how cardiopulmonary resuscitation could be carried out in a weightless environment.



You can see that the technique is rather awkward and questionably effective. To my knowledge, the rescuer falling on the victim is not currently recommended in the latest CPR guidelines.

Assuming that by some miracle the victim survives CPR, what would happen to him? Would he be transferred to the intensive care unit on the spaceship? Would there be a ventilator? What about an endotracheal tube and someone to insert it? Who would monitor the patient? Would that person be subject to work hours limits?

Here’s what I think.

If you have a cardiac arrest on the way to Mars, you’re not only in deep space, you’re in deep doodoo.

25 comments:

Anonymous said...

Deep thoughts there. :)

OldfoolRN said...

I was at Lutheran General Hospital in Park Ridge IL in the early 1970's when it was decided to attempt open heart surgery in a giant hyperbaric chamber. One of the biggest challenges was developing a pneumatically driven heart-lung machine because electric circuits were too hazardous in the chamber. The overhead lights and anything else electric had to be controlled from the outside. From my perspective (a lowly scrub nurse), surgery was at times challenging in a normal environment. It took about a month and several cases before scrapping the hyperbaric chamber OR. The problems far outweighed any theoretical benefit.

I'm glad to see you back posting after your computer snafu. I'm totally clueless with these kind of problems.

Skeptical Scalpel said...

Deep space requires deep thoughts.

OldfoolRN, operating in a hyperbaric chamber sounds like a nightmare, I guess you couldn't use cautery either. I'm not sure what the theoretical benefit would be.

KAC RN said...

I've seen some hair-raising things in the ICU, but this...Okay, so first of all, no short astronauts as they would not be able to reach to top of the cabin to brace themselves. SS, you hit all the other points and the conclusion is as you note: if something bad happens, you die.

Skeptical Scalpel said...

You cannot discriminate against short people. I think if a person was too tall, it wouldn't work either.

KAC RN said...

I think this needs more study. Nothing like throwing money at futility. Maybe a modified Heimlich or a Rube Goldberg invention that would do all the pumping in place of the human component? Then again, there's the ICU suite and equipment...I think we're back to square one: you are not going to make it back to earth in the same state you left.

Anonymous said...

Tall people can bend their knees

Skeptical Scalpel said...

KAC, automatic chest pumpers have been around for >40 years. They aren't too popular and the weight would be a problem for a spaceship full of OR supplies.

Yes, tall people could bend their knees, but it looks like the rescuer needs to be pretty rigid to maintain position over the victim. I'm not sure bent knees will work.

Rayber said...

The Zoll chest compression devise would work. The modified Heimlich if resuscitation wasn't prolonged. In cardiac events resuscitation would be futile as it would be days or weeks before any interventions would be available IF the pt. survived re-entry. The only cases I would think it would be useful would be an electrocution where immediate resuscitation and defibrillator may be successful. Anaphylaxis is very improbable with all the health evaluations an astronaut goes through.

Skeptical Scalpel said...

Rayber, good comments. I forgot about the need for a defibrillator which would add more weight and occupy space on the ship. Some people have asked me if astronauts undergo prophylactic appendectomies. I don't know. Do you?

William Reichert said...

Yes . And if the patient dies, then what? Embalm him or let him rot .
Throw him out the window to get a head start on his way to heaven?
Oh I forgot.Call 911 and wait for the paramedics to show up and drive him to the nearest ER.

Anonymous said...

Anonymous Europe:Training anyone to perform surgery without any medical education is hazardous at least.... I guess the spaceschip that should go to Mars should have artificial gravity and a specially trained doctor. I would call him a "space medicine expert", who can perform and treat a number of situations (from appendicitis to intubation to heart rythm disorders, etc). In my opinion we should not go to Mars till we do not have the proper spaceship.

Skeptical Scalpel said...

I presume dead body disposal has been thought about. I guess you put them in the airlock and open the outer door.

Anon, your plan is a good one but what if the astronaut who gets sick is the specially trained doctor?

frankbill said...

How would you start a IV without gravity? Can you do blood tests without gravity? If you could surgery how would you irrigate the wound?

Skeptical Scalpel said...

I think you could start an IV and draw blood with no gravity. Suction using a syringe or a vacuum tube (as is done on earth) would work. Irrigate the wound? No simple way. You couldn't even contain blood in a wound because it would float away.

frankbill said...

Once you tried to get the blood out of the test tube wouldn't it just float away? With no gravity wouldn't the IV fluid float inside the bag and not flow down the IV line? Maybe the IV pump can pump enough air out and start the fluid. Even in normal use the IV pump doesn't always work good.

Skeptical Scalpel said...

You could aspirate the blood from a tube into a syringe (again suction). An IV would definitely need a pump.

Anonymous said...

Anonymous Europe: Sorry for the late reply, it has been busy overseas. I would take not two but three doctors. It just can not happen that all three gets sick at the same time...
This Mars enterprise is very important ( I truly hope that in my lifetime we get to go there and establish a colony) but we should concentrate on being able to build a proper starship with proper engines, hydroponic gardens etc, before just going there...

Skeptical Scalpel said...

Anon Europe, the more I think about space travel and the logistics of it, the less confident I am that the obstacles can be overcome. Here's one, What about the radiation exposure the astronauts will experience in space? the science fiction novels and movies do not ever mention it.

Dr. Jim DuCanto said...

They're going to need an automated CPR device, either the LUCAS or the Zoll. A channeled video laryngoscope will handle the airway, and they'll need suction and a BVM. We did a Resuscitation simulation in an adverse environment recently, and that is what worked: Resuscitation
Volume 93, August 2015, Pages 40–45, "Mechanical ventilation and resuscitation under water: Exploring one of the last undiscovered environments – A pilot study"

Skeptical Scalpel said...

Very interesting. Here's the link to the abstract http://www.ncbi.nlm.nih.gov/pubmed/26051809.

The problem in space is what are you going to do with both the successfully and unsuccessfully resuscitated victim? As mentioned above, if he dies, he's going to have to be jettisoned. If he lives and needs intensive care, you are going to need a lot more stuff and personnel on the spacecraft.

Dr. Jim DuCanto said...

Simple causes of arrest (transient hypoxia due to "complicated" EVA and electrocution are two examples (like what can happen in a hunting dog in the field) can be treated, and that's about it in this austere example. Recover, great. Die, Great. There may actually be a hatch to toss out the deceased on a ship like this. At the very mimumum, they'll need a body bag storage solution onboard n=x-1, if you get my drift, x being the number of crew members. Love your work man.

Skeptical Scalpel said...

Jim, thanks for the cogent comments and the kind words.

Anonymous said...

A few years ago a journalist told me that "NASA is very good at PR and spends lots of money at it." I suspect this medicine in space thing (surgery, CPR or whatever) mostly serves to portray manned missions as heroic and deserving of lots of taxpayer money.

As for me, I'll postpone my trip to Mars until they have nice, comfy space stations with good medical care, artificial gravity, and jacuzzis.

Skeptical Scalpel said...

I'd like to see a full bar too.

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