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Thierry S, Jaulin F, Starck C, Ariès P, Schmitz J, Kerkhoff S, Bernard CI, Komorowski M, Warnecke T, Hinkelbein J. Evaluation of free-floating tracheal intubation in weightlessness via ice-pick position with a direct laryngoscopy and classic approach with indirect videolaryngoscopy. NPJ Microgravity 2023; 9:73. [PMID: 37684267 PMCID: PMC10491756 DOI: 10.1038/s41526-023-00314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/02/2023] [Indexed: 09/10/2023] Open
Abstract
Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.
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Affiliation(s)
- Séamus Thierry
- Anaesthesiology Department, South Brittany General Hospital, 56100, Lorient, France.
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.
- Medical Simulation Centre B3S, 56100, Lorient, France.
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France.
| | - François Jaulin
- Sorbonne Medical University, Assistance Publique des Hôpitaux de Paris, Paris, France
- Human Factor in Healthcare Association, Group FHS, Paris, France
| | - Clément Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Philippe Ariès
- Anaesthesiology and Intensive Care Department, University Hospital of Brest, 29200, Brest, France
| | - Jan Schmitz
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Steffen Kerkhoff
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Cécile Isabelle Bernard
- Laboratoire Psychologie, Cognition, Communication, Comportement, Université Bretagne Sud, 56000, Vannes, France
| | - Matthieu Komorowski
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tobias Warnecke
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Jochen Hinkelbein
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany
- German Society of Aerospace Medicine (DGLRM), Munich, Germany
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Warnecke T, Dauth L, Ahlbäck A, DuCanto J, Fleischhammer E, Glatz C, Kerkhoff S, Mathes A, Schmitz J, Starck C, Thierry S, Hinkelbein J. Time to ventilation and success rate of airway devices in microgravity: A randomized crossover manikin-trial using an underwater setting. Acta Anaesthesiol Scand 2021; 65:681-687. [PMID: 33440015 DOI: 10.1111/aas.13780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity. METHODS In this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant free-floating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt. RESULTS A total of 20 participants performed placement of each device in both gravity conditions in an Airway mannequin. The fastest time to initial ventilation in simulated microgravity was possible with the laryngeal tube (18.9 ± 8 seconds) followed by laryngeal mask (20.1 ± 9 seconds). The I-gel® supraglottic airway device required substantially more time for successful insertion in simulated microgravity (35.4 ± 25 seconds) as did endotracheal tube intubation by direct laryngoscopy (70.4 ± 35 seconds). Simulated microgravity conditions prolonged time to initial ventilation by 3.3 seconds (LM), 3.9 seconds (LT), 19.9 seconds (I-gel) and 43.1 seconds (endotracheal intubation, ETI) when compared to poolside attempts in normogravity. CONCLUSION In simulated microgravity conditions, use of the laryngeal tube or laryngeal mask provided the quickest time to initial ventilation, without deliberate tethering of the mannequin and rescuer to a fixed surface. Endotracheal intubation required significantly longer procedure times and, thus, was considered insufficient for clinical use in microgravity.
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Affiliation(s)
- Tobias Warnecke
- Department of Anaesthesiology Critical Care Emergency Medicine and Pain Therapy Hospital of OldenburgMedical Campus University of Oldenburg Oldenburg Germany
| | - Lisa Dauth
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Anton Ahlbäck
- Department of Anaesthesiology and Intensive Care Örebro University Hospital Örebro Sweden
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
| | - James DuCanto
- Department of Anaesthesiology Medical College of WisconsinAurora St. Luke's Medical Center Milwaukee WI USA
| | - Elisabeth Fleischhammer
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Carlos Glatz
- Department Medicine Goethe University Frankfurt am Main Frankfurt Germany
| | - Steffen Kerkhoff
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
| | - Alexander Mathes
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
| | - Clement Starck
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- Anesthesiology and Intensive Care Department University Hospital of Brest Brest France
| | - Seamus Thierry
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- Anesthesiology Department South Brittany General Hospital Lorient France
| | - Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine University Hospital of Cologne Cologne Germany
- Space Medicine GroupEuropean Society of Aerospace Medicine (ESAM) Cologne Germany
- German Society of Aerospace Medicine (DGLRM) Munich Germany
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Hinkelbein J, Ahlbäck A, Antwerber C, Dauth L, DuCanto J, Fleischhammer E, Glatz C, Kerkhoff S, Mathes A, Russomano T, Schmitz J, Starck C, Thierry S, Warnecke T. Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation. Sci Rep 2021; 11:9286. [PMID: 33927212 PMCID: PMC8085007 DOI: 10.1038/s41598-021-88008-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/07/2021] [Indexed: 11/09/2022] Open
Abstract
In the next few years, the number of long-term space missions will significantly increase. Providing safe concepts for emergencies including airway management will be a highly challenging task. The aim of the present trial is to compare different airway management devices in simulated microgravity using a free-floating underwater scenario. Five different devices for airway management [laryngeal mask (LM), laryngeal tube (LT), I-GEL, direct laryngoscopy (DL), and video laryngoscopy (VL)] were compared by n = 20 paramedics holding a diving certificate in a randomized cross-over setting both under free-floating conditions in a submerged setting (pool, microgravity) and on ground (normogravity). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the time to ventilation. A total of 20 paramedics (3 female, 17 male) participated in this study. Success rate was highest for LM and LT and was 100% both during simulated microgravity and normogravity followed by the I-GEL (90% during microgravity and 95% during normogravity). However, the success rate was less for both DL (60% vs. 95%) and VL (20% vs. 60%). Fastest ventilation was performed with the LT both in normogravity (13.7 ± 5.3 s; n = 20) and microgravity (19.5 ± 6.1 s; n = 20). For the comparison of normogravity and microgravity, time to ventilation was shorter for all devices on the ground (normogravity) as compared underwater (microgravity). In the present study, airway management with supraglottic airways and laryngoscopy was shown to be feasible. Concerning the success rate and time to ventilation, the optimum were supraglottic airways (LT, LM, I-GEL) as their placement was faster and associated with a higher success rate. For future space missions, the use of supraglottic airways for airway management seems to be more promising as compared to tracheal intubation by DL or VL.
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany. .,German Society of Aerospace Medicine (DGLRM), Munich, Germany.
| | - Anton Ahlbäck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Department of Anaesthesiology and Intensive Care, Örebro University Hospital , Örebro, Sweden
| | - Christine Antwerber
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Lisa Dauth
- Department for Anaesthesiology and Intensive Care Medicine, St. Elisabeth Hospital, Cologne, Germany
| | - James DuCanto
- Department of Anaesthesiology, Medical College of Wisconsin, Aurora St. Luke's Medical Center, Milwaukee, USA
| | - Elisabeth Fleischhammer
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Carlos Glatz
- Department of Medicine, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Steffen Kerkhoff
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Alexander Mathes
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Thais Russomano
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Jan Schmitz
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,German Society of Aerospace Medicine (DGLRM), Munich, Germany
| | - Clement Starck
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anaesthesiology and Intensive Care Department, University Hospital of Brest, Brest, France
| | - Seamus Thierry
- Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany.,Anaesthesiology Department, South Brittany General Hospital, Lorient, France
| | - Tobias Warnecke
- Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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Schick V, Dusse F, Eckardt R, Kerkhoff S, Commotio S, Hinkelbein J, Mathes A. Comparison of Volume-Guaranteed or -Targeted, Pressure-Controlled Ventilation with Volume-Controlled Ventilation during Elective Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10061276. [PMID: 33808607 PMCID: PMC8003546 DOI: 10.3390/jcm10061276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022] Open
Abstract
For perioperative mechanical ventilation under general anesthesia, modern respirators aim at combining the benefits of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in modes typically named “volume-guaranteed” or “volume-targeted” pressure-controlled ventilation (PCV-VG). This systematic review and meta-analysis tested the hypothesis that PCV-VG modes of ventilation could be beneficial in terms of improved airway pressures (Ppeak, Pplateau, Pmean), dynamic compliance (Cdyn), or arterial blood gases (PaO2, PaCO2) in adults undergoing elective surgery under general anesthesia. Three major medical electronic databases were searched with predefined search strategies and publications were systematically evaluated according to the Cochrane Review Methods. Continuous variables were tested for mean differences using the inverse variance method and 95% confidence intervals (CI) were calculated. Based on the assumption that intervention effects across studies were not identical, a random effects model was chosen. Assessment for heterogeneity was performed with the χ2 test and the I2 statistic. As primary endpoints, Ppeak, Pplateau, Pmean, Cdyn, PaO2, and PaCO2 were evaluated. Of the 725 publications identified, 17 finally met eligibility criteria, with a total of 929 patients recruited. Under supine two-lung ventilation, PCV-VG resulted in significantly reduced Ppeak (15 studies) and Pplateau (9 studies) as well as higher Cdyn (9 studies), compared with VCV [random effects models; Ppeak: CI −3.26 to −1.47; p < 0.001; I2 = 82%; Pplateau: −3.12 to −0.12; p = 0.03; I2 = 90%; Cdyn: CI 3.42 to 8.65; p < 0.001; I2 = 90%]. For one-lung ventilation (8 studies), PCV-VG allowed for significantly lower Ppeak and higher PaO2 compared with VCV. In Trendelenburg position (5 studies), this effect was significant for Ppeak only. This systematic review and meta-analysis demonstrates that volume-targeting, pressure-controlled ventilation modes may provide benefits with respect to the improved airway dynamics in two- and one-lung ventilation, and improved oxygenation in one-lung ventilation in adults undergoing elective surgery.
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Hinkelbein J, Schmitz J, Kerkhoff S, Eifinger F, Truhlář A, Schick V, Adler C, Kalina S. On-board emergency medical equipment of European airlines. Travel Med Infect Dis 2021; 40:101982. [PMID: 33545394 DOI: 10.1016/j.tmaid.2021.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Medical emergencies frequently occur in commercial airline flights, but valid data on causes and consequences are rare. Therefore, optimal extent of onboard emergency medical equipment remains largely unknown. Whereas a minimum standard is defined in regulations, additional material is not standardized and may vary significantly between airlines. METHODS European airlines operating aircrafts with at least 30 seats were selected and interviewed with a 5-page written questionnaire including 81 items. Besides pre-packed and required emergency medical material, drugs, medical devices, and equipment lists were queried. If no reply was received, airlines were contacted up to three times by email and/or phone. Descriptive analysis was used for data interpretation. RESULTS From a total of 305 European airlines, 253 were excluded from analysis (e.g., no passenger transport). 52 airlines were contacted and data of 22 airlines were available for analysis (one airline was excluded due to insufficient data). A first aid kit is available on all airlines. 82% of airlines (18/22) reported to have a "doctor's kit" (DK) or an "Emergency Medical Kit" (EMK) onboard. 86% of airlines (19/22) provide identical equipment in all aircraft of the fleet, and 65% (14/22) airlines provide an automated external defibrillator. CONCLUSIONS Whereas minimal required material according to European aviation regulations is provided by all airlines for medical emergencies, there are significant differences in availability of the additional material. The equipment of most airlines is not sufficient for treatment of specific emergencies according to published in-flight medical guidelines (e.g., for CPR or acute myocardial infarction).
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Affiliation(s)
- Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Working Group "Standards, Recommendations, and Guidelines", German Society of Aviation and Space Medicine, Munich, Germany.
| | - Jan Schmitz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany; Working Group "Emergency Medicine and Air Rescue", German Society of Aviation and Space Medicine, Munich, Germany; Working Group "Standards, Recommendations, and Guidelines", German Society of Aviation and Space Medicine, Munich, Germany.
| | - Steffen Kerkhoff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Frank Eifinger
- Department of Paediatrics, Krankenhaus Porz, Cologne, Germany.
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, Charles University Prague, Faculty of Medicine Hradec Králové, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Volker Schick
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Christoph Adler
- Department of Cardiology, University Hospital of Cologne, Cologne, Germany; Fire Department City of Cologne, Institute for Security Science and Rescue Technology, Cologne, Germany.
| | - Steffen Kalina
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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7
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Warnecke T, Tochtermann F, Kerkhoff S, Komorowski M, Neuhaus C, Hinkelbein J. Airway management in microgravity: A systematic review. Acta Anaesthesiol Scand 2019; 63:2-7. [PMID: 30203439 DOI: 10.1111/aas.13251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the near future, space programs will shift their focus toward long-duration interplanetary missions, in particular to the Moon and Mars. These exploration missions will be associated with an increased risk of acute medical problems, which will need to be handled by an autonomous crew operating in extreme isolation. An important skill in emergencies is represented by airway management. Many airway devices are available and it is unclear which one would be the most suitable in the context of a space mission. The aim of this systematic review was to analyze the existing literature on airway management in the special situation of weightlessness during space missions. MATERIAL AND METHODS We performed a standardized review of published literature on airway management in spaceflight and analogue environments using the database PubMed. RESULTS We identified a total of 3111 publications of which 3039 were initially excluded after evaluation. The screening identified three randomized comparative manikin studies, two of them in parabolic flights, one in a submerged setup. Under free-floating conditions, the insertion success rate of supraglottic airway devices (SGA) was excellent (91%-97%). The administration of artificial ventilation could be successfully achieved in weightlessness with SGA. The success rate of conventional laryngoscopy under free-floating conditions fluctuated between 15% and 86%. CONCLUSION It appears possible to safely manage the airway in weightlessness, provided that certain conditions are ensured, such as restraining the patient and operator for conventional orotracheal intubation. If airway protection is required with endotracheal intubation, both the operator and the patient should be restrained.
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Affiliation(s)
- Tobias Warnecke
- Department of Anesthesiology; Evangelisches Krankenhaus Duisburg; Duisburg Germany
| | | | - Steffen Kerkhoff
- Department of Anesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne Germany
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
| | - Matthieu Komorowski
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Christopher Neuhaus
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- Department of Anesthesiology; University Hospital of Heidelberg; Heidelberg Germany
| | - Jochen Hinkelbein
- Department of Anesthesiology and Intensive Care Medicine; University Hospital of Cologne; Cologne Germany
- German Society of Aerospace Medicine (DGLRM); Munich Germany
- European Society of Aerospace Medicine (ESAM); Space Medicine Group; Cologne Germany
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Warnecke T, Schmitz J, Kerkhoff S, Hinkelbein J. Anästhesie bei Patienten mit NBIA. Anaesthesist 2018; 67:871-877. [DOI: 10.1007/s00101-018-0488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Engelsma MY, Kerkhoff S, Roozenburg I, Haenen OLM, Gool A, Sistermans W, Wijnhoven S, Hummel H. Epidemiology of Bonamia ostreae infecting European flat oysters Ostrea edulis from Lake Grevelingen, The Netherlands. ENDANGER SPECIES RES 2010. [DOI: 10.3354/esr08594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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