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Hinkelbein J, Kerkhoff S, Adler C, Ahlbäck A, Braunecker S, Burgard D, Cirillo F, De Robertis E, Glaser E, Haidl TK, Hodkinson P, Iovino IZ, Jansen S, Johnson KVL, Jünger S, Komorowski M, Leary M, Mackaill C, Nagrebetsky A, Neuhaus C, Rehnberg L, Romano GM, Russomano T, Schmitz J, Spelten O, Starck C, Thierry S, Velho R, Warnecke T. 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). Scand J Trauma Resusc Emerg Med 2020; 28:108. [PMID: 33138865 PMCID: PMC7607644 DOI: 10.1186/s13049-020-00793-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jochen Hinkelbein
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany. .,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany. .,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.
| | - Steffen Kerkhoff
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
| | - Christoph Adler
- Department of Internal Medicine III, Heart Centre of the University of Cologne, Cologne, Germany.,Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany
| | - Anton Ahlbäck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - Stefan Braunecker
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anesthesiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Daniel Burgard
- Department of Cardiology and Angiology, Heart Center Duisburg, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - Fabrizio Cirillo
- Department of Anaesthesia and Intensive Care, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Edoardo De Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Eckard Glaser
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,, Gerbrunn, Germany
| | - Theresa K Haidl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937, Cologne, Germany
| | - Pete Hodkinson
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Aerospace Medicine, Centre of Human and Applied Physiological Sciences, King's College, London, UK
| | - Ivan Zefiro Iovino
- Department of Anaesthesia and Intensive Care, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, 50937, Cologne, Germany
| | | | - Saskia Jünger
- Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Matthieu Komorowski
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Exhibition road, London, SW7 2AZ, UK
| | - Marion Leary
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Mackaill
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Accident and Emergency Department, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Alexander Nagrebetsky
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christopher Neuhaus
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucas Rehnberg
- University Hospital Southampton NHS Foundation Trust, Anaesthetic Department, Southampton, UK
| | | | - Thais Russomano
- Centre of Human and Applied Physiological Sciences, Kings College London, London, UK
| | - Jan Schmitz
- German Society of Aviation and Space Medicine (DGLRM), Munich, Germany.,Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
| | - Oliver Spelten
- Department of Anaesthesiology and Intensive Care Medicine, Schön Klinik Düsseldorf, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Germany
| | - Clément Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anesthesiology Department, Brest University Hospital, Brest, France
| | - Seamus Thierry
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anesthesiology Department, Bretagne Sud General Hospital, Lorient, France.,Medical and Maritime Simulation Center, Lorient, France.,Laboratory of Psychology, Cognition, Communication and Behavior, University of Bretagne Sud, Vannes, France
| | - Rochelle Velho
- Academic Department of Anaesthesia, Critical Care, Pain and Resuscitation, University Hospitals Birmingham, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tobias Warnecke
- University Department for Anesthesia, Intensive and Emergency Medicine and Pain Management, Hospital Oldenburg, Oldenburg, Germany
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Hinkelbein J, Böhm L, Braunecker S, Genzwürker HV, Kalina S, Cirillo F, Komorowski M, Hohn A, Siedenburg J, Bernhard M, Janicke I, Adler C, Jansen S, Glaser E, Krawczyk P, Miesen M, Andres J, De Robertis E, Neuhaus C. In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German Society of Aerospace Medicine (DGLRM). Intern Emerg Med 2018; 13:1305-1322. [PMID: 29730774 DOI: 10.1007/s11739-018-1856-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 04/21/2018] [Indexed: 01/08/2023]
Abstract
By the end of the year 2016, approximately 3 billion people worldwide travelled by commercial air transport. Between 1 out of 14,000 and 1 out of 50,000 passengers will experience acute medical problems/emergencies during a flight (i.e., in-flight medical emergency). Cardiac arrest accounts for 0.3% of all in-flight medical emergencies. So far, no specific guideline exists for the management and treatment of in-flight cardiac arrest (IFCA). A task force with clinical and investigational expertise in aviation, aviation medicine, and emergency medicine was created to develop a consensus based on scientific evidence and compiled a guideline for the management and treatment of in-flight cardiac arrests. Using the GRADE, RAND, and DELPHI methods, a systematic literature search was performed in PubMed. Specific recommendations have been developed for the treatment of IFCA. A total of 29 specific recommendations for the treatment and management of in-flight cardiac arrests were generated. The main recommendations included emergency equipments as well as communication of the emergency. Training of the crew is of utmost importance, and should ideally have a focus on CPR in aircraft. The decision for a diversion should be considered very carefully.
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Affiliation(s)
- Jochen Hinkelbein
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany.
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany.
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany.
| | - Lennert Böhm
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Stefan Braunecker
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Critical Care, King's College Hospital, London, UK
| | | | - Steffen Kalina
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | - Fabrizio Cirillo
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Matthieu Komorowski
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Andreas Hohn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Cologne, 50937, Cologne, Germany
| | | | - Michael Bernhard
- Emergency Department, University of Duesseldorf, Düsseldorf, Germany
| | - Ilse Janicke
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department for Cardiology and Angiology, Heart Center Duisburg, Evangelisches Klinikum Niederrhein, Duisburg, Germany
| | - Christoph Adler
- Department of Internal Medicine III, Heart Center of the University of Cologne, Cologne, Germany
| | - Stefanie Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
| | - Eckard Glaser
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- , Gerbrunn, Germany
| | - Pawel Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | | | - Janusz Andres
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Christopher Neuhaus
- Working group "guidelines, recommendations, and statements", German Society of Aviation and Space Medicine, Munich, Germany
- Working group "emergency medicine and air rescue", German Society of Aviation and Space Medicine, Munich, Germany
- Department of Anaesthesiology, University Hospital Heidelberg, Heidelberg, Germany
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Costantino G, Podda GM, Falsetti L, Iannone P, Lages A, Marra AM, Masala M, Reiakvam OM, Savva F, Schovanek J, van Bree S, da Silva Chora IJ, Privitera G, Ragozzino S, von Rotz M, Woittiez L, Davidson C, Montano N. Guidelines on the management of atrial fibrillation in the emergency department: a critical appraisal. Intern Emerg Med 2017; 12:693-703. [PMID: 27905006 DOI: 10.1007/s11739-016-1580-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/19/2016] [Indexed: 01/24/2023]
Abstract
Several guidelines often exist on the same topic, sometimes offering divergent recommendations. For the clinician, it can be difficult to understand the reasons for this divergence and how to select the right recommendations. The aim of this study is to compare different guidelines on the management of atrial fibrillation (AF), and provide practical and affordable advice on its management in the acute setting. A PubMed search was performed in May 2014 to identify the three most recent and cited published guidelines on AF. During the 1-week school of the European School of Internal Medicine, the attending residents were divided in five working groups. The three selected guidelines were compared with five specific questions. The guidelines identified were: the European Society of Cardiology guidelines on AF, the Canadian guidelines on emergency department management of AF, and the American Heart Association guidelines on AF. Twenty-one relevant sub-questions were identified. For five of these, there was no agreement between guidelines; for three, there was partial agreement; for three data were not available (issue not covered by one of the guidelines), while for ten, there was complete agreement. Evidence on the management of AF in the acute setting is largely based on expert opinion rather than clinical trials. While there is broad agreement on the management of the haemodynamically unstable patient and the use of drugs for rate-control strategy, there is less agreement on drug therapy for rhythm control and no agreement on several other topics.
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Affiliation(s)
- Giorgio Costantino
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy.
| | - Gian Marco Podda
- Unità di Medicina 3, Dipartimento di medicina Interna, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lorenzo Falsetti
- Medicina Interna Generale e Semintensiva, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Primiano Iannone
- Dipartimento di Emergenza, Ospedale del Tigullio, ASL4 Chiavarese, Lavagna, Genoa, Italy
| | - Ana Lages
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Maristella Masala
- Azienda Ospedaliera Universitaria AOU Sassari Medicina Interna, Sassari, Italy
| | | | - Florentia Savva
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Jan Schovanek
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Sjoerd van Bree
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Graziella Privitera
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Silvio Ragozzino
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Matthias von Rotz
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | - Lycke Woittiez
- The 22nd European Summer School of Internal Medicine, Muravera, Cagliari, Italy
| | | | - Nicola Montano
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Dipartimento di Medicina Interna, Allergologia Immunologia Clinica, Università degli Studi di Milano, Via F. Sforza 34, Milan, Italy
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