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).

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.

A new method for the performance of external chest compressions during hypogravity simulation.

INTRODUCTION: 2015 UK resuscitation guidelines aim for 50-60 mm depth when giving external chest compressions (ECCs). This is achievable in hypogravity if the rescuer flexes and extends their arms during CPR, or using a new method trialed; the 'Mackaill-Russomano' (MR CPR) method. METHODS: 10 participants performed 3 sets of 30 ECCs in accordance with 2015 guidelines. A control was used at 1Gz, with eight further conditions using Mars and Moon simulations, with and without braces in the terrestrial position and using the MR CPR method. The MR CPR method involved straddling the mannequin, using its legs for stabilization. A body suspension device, with counterweights, simulated hypogravity environments. ECC depth, rate, angle of arm flexion and heart rate (HR) were measured. RESULTS: Participants completed all conditions, and ECC rate was achieved throughout. Mean (±â€¯SD) ECC depth using the MR CPR method at 0.38Gz was 54.1 ±â€¯0.55 mm with braces; 50.5 ±â€¯1.7 mm without. ECCs were below 50 mm at 0.17Gz using the MR CPR method (47.5 ±â€¯1.47 mm with braces; 47.4 ±â€¯0.87 mm without). In the terrestrial position, ECCs were more effective without braces (49.4 ±â€¯0.26 mm at 0.38Gz; 43.9 ±â€¯0.87 mm at 0.17Gz) than with braces (48.5 ±â€¯0.28 mm at 0.38Gz; 42.4 ±â€¯0.3 mm at 0.17Gz). Flexion increased from approximately 2° - 8° with and without braces respectively. HR did not change significantly from control. DISCUSSION: 2015 guidelines were achieved using the MR CPR method at 0.38Gz, with no significant difference with and without braces. Participants were closer to achieving the required ECC depth in the terrestrial position without braces. ECC depth was not achieved at 0.17Gz, due to a greater reduction in effective body weight.