Non-terrestrial

CPR in Microgravity
Basic Life Support
Simon N Evetts PhD
Thais Russomano MD PhD
John Ernsting MBBS PhD
Subhajit Sarkar MRCS
Lisa Evetts RGN
João Castro MD
Microgravity Laboratory, PUCRS, Porto Alegre, Brazil.
Human Physiology and Aerospace Medicine Group, King’s
College London.
 Introduction
 Non-terrestrial as opposed to microgravity.
 Introduction
 Non-terrestrial as opposed to microgravity.
 Basic Life Support;
 Introduction
 Non-terrestrial as opposed to microgravity.
 Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
 Introduction
 Non-terrestrial as opposed to microgravity.
 Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
 Introduction
 Non-terrestrial as opposed to microgravity.
 Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
 Single rescuer, not multiple care-giver.
 Introduction
 Non-terrestrial as opposed to microgravity.
 Basic Life Support;
– Cardiopulmonary Resuscitation without equipment
or other resources.
 Single rescuer, not multiple care-giver.
 Emphasis on chest compression, mouth-to-
mouth ventilation secondary consideration.
 The Space Environment
 Space exploration is inherently dangerous.
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Significant Space Related
Medical Occurrences
Year Mission Nation Event
1967 Soyuz 1 USSR Spacecraft crashed – 1 death
1967 Apollo 1 US Command module fire – 3 deaths
1969 Apollo 11 US Type 1 decompression sickness
1970 Apollo 13 US Urinary tract infection
1971 Soyuz 11 USSR Depressurization – 3 deaths
1971 Apollo 15 US Arrhythmia during lunar EVA
1975 Apollo 18 US Nitrogen tetroxide pneumonitis
1985 Salyut 7 USSR Prostatis and sepsis
1985 Salyut 7 USSR Hypothermia
1986 Challenger US Spacecraft exploded - 7 deaths
1987 Mir Russia Arrhythmia requiring evacuation
1997 Mir Russia Depressurization after collision
1997 Mir Russia Toxic atmosphere after fire
2003 Columbia US Spacecraft disintegrated – 7 deaths
 Pulseless victim
 The Space Medicine Configuration Control Board of NASA
has approved a list of 442 medical conditions (the Patient
Condition Database) that appear possible during long
duration spaceflight on the ISS.
 Pulseless victim
 The Space Medicine Configuration Control Board of NASA
has approved a list of 442 medical conditions (the Patient
Condition Database) that appear possible during long
duration spaceflight on the ISS.
 Of these conditions 106 (24 %) are classified as “critical”
requiring use of critical care procedures.
 Pulseless victim
 The Space Medicine Configuration Control Board of NASA
has approved a list of 442 medical conditions (the Patient
Condition Database) that appear possible during long
duration spaceflight on the ISS.
 Of these conditions 106 (24 %) are classified as “critical”
requiring use of critical care procedures.
 …including cardiac conditions (e.g. myocardial infarction,
ventricular fibrillation, ventricular tachycardia, and asystole),
 Pulseless victim
 The Space Medicine Configuration Control Board of NASA
has approved a list of 442 medical conditions (the Patient
Condition Database) that appear possible during long
duration spaceflight on the ISS.
 Of these conditions 106 (24 %) are classified as “critical”
requiring use of critical care procedures.
 …including cardiac conditions (e.g. myocardial infarction,
ventricular fibrillation, ventricular tachycardia, and asystole),
 …and respiratory conditions (e.g. acute airway obstruction,
laryngeal oedema from anaphylaxis and inhalation injuries).
 Pulseless victim
 It has been estimated that the risk to an ISS crew member of
developing a serious medical condition requiring medical
evacuation is 6% per year*,

* Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of
Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific
Meeting of the Aerospace Medical Association, Houston, Texas. May 2000.
 Pulseless victim
 It has been estimated that the risk to an ISS crew member of
developing a serious medical condition requiring medical
evacuation is 6% per year*,
 … and 1% per year risk of a life-threatening condition*.

* Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of
Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific
Meeting of the Aerospace Medical Association, Houston, Texas. May 2000.
 Pulseless victim
 It has been estimated that the risk to an ISS crew member of
developing a serious medical condition requiring medical
evacuation is 6% per year*,
 … and 1% per year risk of a life-threatening condition*.
 A figure of 0.15%/yr of CAD related event occurring in 35-
45 yr old flight personnel has been cited**.
* Johnston, S. L., Marshburn, T. H., and Lindgren, K., 2000. Predicted Incidence of
Evacuation-Level Illness/Injury During Space Station Operation. 71st Annual Scientific
Meeting of the Aerospace Medical Association, Houston, Texas. May 2000.

** Ball, C.G., Hamilton, D.R. and Kirkpatrick, A. 2004. Primary prevention approach to
mitigating cardiac risk in astronauts. 75th Annual Scientific Meeting of the Aerospace
Medical Association, Houston, Anchorage. May 2004.
 Pulseless victim
 As has the figure of 0.06 persons/year with regards to the risk
of a healthy astronaut receiving a significant injury or
developing a significant medical condition in space*.

* Mukai, C. and Charles, J. B. 2004. Psychological and medical challenges for Mars
crew composition as considered against similar challenges faced by the Lewis and Clark
Expedition. 75th Annual Scientific Meeting of the Aerospace Medical Association,
Houston, Anchorage. May 2004.
 Pulseless victim
 As has the figure of 0.06 persons/year with regards to the risk
of a healthy astronaut receiving a significant injury or
developing a significant medical condition in space*.
 The potential for a serious medical incident resulting in a
pulseless apneic state requiring intervention, therefore is real.

* Mukai, C. and Charles, J. B. 2004. Psychological and medical challenges for Mars
crew composition as considered against similar challenges faced by the Lewis and Clark
Expedition. 75th Annual Scientific Meeting of the Aerospace Medical Association,
Houston, Anchorage. May 2004.
 Recent and current CPR
guidelines (+1Gz)
 European Resuscitation Council 1998:
– Mouth-to-mouth ventilation requiring tidal volumes of
400 – 600 ml.
– Chest compression depth of 40 – 50 mm.
– Chest compression rate of ~ 100 compressions.min-1.
 Recent and current CPR
guidelines (+1Gz)
 European Resuscitation Council 1998:
– Mouth-to-mouth ventilation requiring tidal volumes of
400 – 600 ml.
– Chest compression depth of 40 – 50 mm.
– Chest compression rate of ~ 100 compressions.min-1.
 European Resuscitation Council 2001:
– Tidal volumes of 700 – 1000 ml.
– Chest compression depth of 40 – 50 mm.
– Chest compression rate in excess of 100 min-1.
+1Gz - Earth
 Chest Compression Depth
According to Rescuer Body Weight
Earth
Earth GravityGravity
(9.8 ms-2)
Big patient/low 9.8 m.s-1
β +2 s.d., β +1s.d.,
Average
Mean compliance chest
β -1s.d.,

1000
compliance chest γ +2 s.d. γ +1s.d. γ -1s.d.

900 7.0 93 kg person

800

700
6.1 76 kg person
600 Min required
(N)
Force (N)

500
depth
Force

400 4.1 41 kg person

300 β -2 s.d.,
γ -2 s.d.

200 Minimum required Small patient/high

depth (3.8 cm)
100 compliance chest
0
0 1 2 3 4 5 6 7 8 9 10 11

Compression
Com pression Depth
depth (cm )(cm)
+0.16 Gz - The Moon
+0.16 Gz - The Moon
 Chest Compression Depth
According to Rescuer Body Weight
Lunar Gravity (1.62 ms-2)
Lunar Gravity
β +2 s.d., β +1s.d., β -1s.d.,
Mean
1000
γ +2 s.d.
Average compliance chest
γ +1s.d. γ -1s.d.

900

800

700

600
(N)
Force (N)

500
Force

400 Small patient/high

300 compliance chest βs.d.,
-2

γ -2 s.d.
Minimum required
200
depth (3.8 cm) 93 kg
2.0
1.7 76 kg
100
1.0
0 41 kg
0 1 2 3 4 5 6 7 8 9 10 11

Compression Depth (cm)

Com pression depth (cm )
+0.38 Gz - Mars
+0.38 Gz - Mars
+0.38 Gz - Mars
Spaceman Spiff wrestles with his
Galactic Mk 3 Mars Lander, but
what with muscle wastage,
deconditioning and Martian death
rays, the landing wasn’t looking
too good!!
+0.38 Gz - Mars
 Chest Compression Depth
According to Rescuer Body Weight
Mars Gravity (3.71 ms-2)
Mars Gravity
β +2 s.d., β +1s.d., β -1s.d.,
γ +2 s.d. Average
γ +1s.d.Meancompliance chest
γ -1s.d..
1000

900

800

700

600
(N)
(N)

Small patient/high
Force

500 compliance chest

Force

400
3.7 93 kg
300 3.2
β -2
76 kg
s.d.,
200 γ -2 s.d..
2.0
Minimum 41 kg
100
required depth
0
0 1 2 3 4 5 6 7 8 9 10 11
Com pression depth (cm )
Compression Depth (cm)
 Mean Mass Rescuer – Mean Chest
Compliance Patient
76 kg provider - Mean compliance chest - Different gravities

1000 76 kg Rescuer
900

800
6.1
On Earth
700

600
Force (N)
Force (N)

500

400

300 3.2 On Mars

Minimum required
200
1.7
depth (3.8 cm) On Moon
100

0
0 1 2 3 4 5 6 7 8 9 10 11
Com pression depth (cm )
Compression Depth (cm)
 What can be done about off
planet BLS?
 Assisted CPR.
– Using a restraint system.
 What can be done about off
planet BLS?
 Assisted CPR.
– Using a restraint system.
 What can be done about off
planet BLS?
 Assisted CPR.
– Using a restraint system.
– Using assistance devices.
 What can be done about off
planet BLS?
 Assisted CPR.
– Using a restraint system.
– Using assistance devices.
– Multiple person CPR.
 What can be done about off
planet BLS?
Technique of Equipment Description
compression

Standard Nil Normal terrestrial CPR method.

Heimlich CPR Nil Rescuer behind patient, chest

Method compression by elbow flexion.

Abdominal Nil Abdomen compressed to utilize pure

compression abdominal pump mechanism.

Mass Nil Dropping from a height provides

momentum potential energy. The force may be
method applied by the hands or the feet.
 What can be done about off
planet BLS?
Technique of Equipment Description
compression

Standard Nil Normal terrestrial CPR method.

Heimlich CPR Nil Rescuer behind patient, chest

Method compression by elbow flexion.

Abdominal Nil Abdomen compressed to utilize pure

compression abdominal pump mechanism.

Mass Nil Dropping from a height provides

momentum potential energy. The force may be
method applied by the hands or the feet.
 What can be done about off
planet BLS?
Technique of Equipment Description
compression

Standard Nil Normal terrestrial CPR method.

Heimlich CPR Nil Rescuer behind patient, chest

Method compression by elbow flexion.
(RBH)
Abdominal Nil Abdomen compressed to utilize pure
compression abdominal pump mechanism.

Mass Nil Dropping from a height provides

momentum potential energy. The force may be
method applied by the hands or the feet.
 What can be done about off
planet BLS?
Technique of Equipment Description
compression

Standard Nil Normal terrestrial CPR method.

Heimlich CPR Nil Rescuer behind patient, chest

Method compression by elbow flexion.

Abdominal Nil Abdomen compressed to utilize pure

compression abdominal pump mechanism.

Mass Nil Dropping from a height provides

momentum potential energy. The force may be
method applied by the hands or the feet.
 What can be done about off
planet BLS?
Technique of Equipment Description
compression

Standard Nil Normal terrestrial CPR method.

Heimlich CPR Nil Rescuer behind patient, chest

Method compression by elbow flexion.

Abdominal Nil Abdomen compressed to utilize pure

compression abdominal pump mechanism.

Mass Nil Dropping from a height provides

momentum potential energy. The force may be
method applied by the hands or the feet.
 What can be done about off
planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs
to enable additional force application
through hip/knee flexion.

Added mass Weights Standard method with added masses

(e.g. on a weight belt).

Assist device Elastic Large ‘elastic band’ placed around the

compression patient’s back and over the rescuer’s
assist device shoulders/back provides additional
force.
Modified Opposing Modification of the microgravity hand-
Hand-stand ‘walls’ approx stand method.
Method (HS) 2m apart.
 What can be done about off
planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs
to enable additional force application
through hip/knee flexion

Added mass Weights Standard method with added masses

(e.g. on a weight belt).

Assist device Elastic Large ‘elastic band’ placed around the

compression patient’s back and over the rescuer’s
assist device shoulders/back provides additional
force.
Modified Opposing Modification of the microgravity hand-
Hand-stand ‘walls’ approx stand method.
Method (HS) 2m apart.
 What can be done about off
planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs
to enable additional force application
through hip/knee flexion

Added mass Weights Standard method with added masses

(e.g. on a weight belt).

Assist device Elastic Large ‘elastic band’ placed around the

compression patient’s back and over the rescuer’s
assist device shoulders/back provides additional
force.
Modified Opposing Modification of the microgravity hand-
Hand-stand ‘walls’ approx stand method.
Method (HS) 2m apart.
 What can be done about off
planet BLS?
ER Method Nil Patient thorax encircled by rescuer legs
to enable additional force application
through hip/knee flexion

Added mass Weights Standard method with added masses

(e.g. on a weight belt).

Assist device Elastic Large ‘elastic band’ placed around the

compression patient’s back and over the rescuer’s
assist device shoulders/back provides additional
force.
Modified Opposing Modification of the microgravity hand-
Hand-stand ‘walls’ approx stand method.
Method (HS) 2m apart.
 N.B.

• A major limitation of all microgravity BLS

methods is the lack of back/neck/head support!
 N.B.

• A major limitation of all microgravity BLS

methods is the lack of back/neck/head support!
• A decision will need to be made as whether a
potential back/neck injury poses a greater risk
than not receiving adequate CPR.
 Lets Walk Before We
Can Run
(Fly before we bound)
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Lets Walk Before
We Can Run
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Current unrestrained Basic Life Support
methods.
 Lets Walk Before
We Can Run
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Current unrestrained Basic Life Support
methods.
– Hand stand method
Hand Stand method
 Lets Walk Before
We Can Run
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Current unrestrained Basic Life Support
methods.
– Hand stand method
– Reverse bear-hug (Heimlich).
 Reverse Bear-hug
(Modified Heimlich).
 Lets Walk Before
We Can Run
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Current unrestrained Basic Life Support
methods.
– Hand stand method
– Reverse bear-hug (Heimlich).
 Limitations.
 Lets Walk Before
We Can Run
 Can Cardiopulmonary Resuscitation be
performed by anyone, anywhere when off
planet?
 Current unrestrained Basic Life Support
methods.
– Hand stand method
– Reverse bear-hug (Heimlich).
 Limitations.
 Can a method of CPR (with fewer limitations
than current methods) be performed by
anyone, anywhere when off planet?
King’s/PUCRS CPR in
Microgravity Study
ER CPR method –
chest compression potential.
ER CPR method –
chest compression potential.
ER CPR method –
chest compression potential.
ER CPR method –
chest compression potential.
ER method –
ventilation potential.
ER method –
ventilation potential.
Manikin trials.
Manikin trials.
Manikin trials.
 Results
Measure +1GZ Microgravity
Chest Compressions
Depth (mm) 43.6 ± 0.59 41.3 ± 1.03
Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2
Rate (compressions.min-1) 97.1 ± 3.0 80.2 ± 3.4
Percent correct (depth) 90% 60%
n 225 672
Tidal Volume
Volume (ml) 507.6 ± 11.5 491 ± 50.4
Range (min-max, ml) 423 – 570 284 - 891
Percent correct 87% 69%
n 30 32
 Results
Measure +1GZ Microgravity
Chest Compressions
Depth (mm) 43.6 ± 0.59 41.3 ± 1.03
Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2
Rate (compressions.min-1) 97.1 ± 3.0 80.2 ± 3.4
Percent correct (depth) 90% 60%
n 225 672
Tidal Volume
Volume (ml) 507.6 ± 11.5 491 ± 50.4
Range (min-max, ml) 423 – 570 284 - 891
Percent correct 87% 69%
n 30 32
 Results
Measure +1GZ Microgravity
Chest Compressions
Depth (mm) 43.6 ± 0.59 41.3 ± 1.03
Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2
Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 *
Percent correct (depth) 90% 60%
n 225 672
Tidal Volume
Volume (ml) 507.6 ± 11.5 491 ± 50.4
Range (min-max, ml) 423 – 570 284 - 891
Percent correct 87% 69%
n 30 32
* P < 0.05
 Results
Measure +1GZ Microgravity
Chest Compressions
Depth (mm) 43.6 ± 0.59 41.3 ± 1.03
Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2
Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 *
Percent correct (depth) 90% 60%
n 225 672
Tidal Volume
Volume (ml) 507.6 ± 11.5 491 ± 50.4
Range (min-max, ml) 423 – 570 284 - 891
Percent correct 87% 69%
n 30 32
 Results
Measure +1GZ Microgravity
Chest Compressions
Depth (mm) 43.6 ± 0.59 41.3 ± 1.03
Range (min-max, mm) 40.4 – 47.1 27.6 – 51.2
Rate (compressions.min-1) 97.1 ± 3.0 * 80.2 ± 3.4 *
Percent correct (depth) 90% 60%
n 225 672
Tidal Volume
Volume (ml) 507.6 ± 11.5 491 ± 50.4
Range (min-max, ml) 423 – 570 284 - 891
Percent correct 87% 69%
n 30 32
 Discussion
 Reasons for insufficient rate of chest
compression and greater variation of
measures in microgravity.
 Discussion
 Reasons for insufficient rate of chest
compression and greater variation of
measures in microgravity.
– Novelty of environment.
 Discussion
 Reasons for insufficient rate of chest
compression and greater variation of
measures in microgravity.
– Novelty of environment.
– Variable acceleration forces and shortness of
microgravity exposure.
 Discussion
 Reasons for insufficient rate of chest
compression and greater variation of
measures in microgravity.
– Novelty of environment.
– Variable acceleration forces and shortness of
microgravity exposure.
– Use of +1Gz manikin (albeit adapted for
microgravity use).
 Discussion
 ER compared to other methods of performing CPR in
microgravity.
Measure ER Hand Rev Bear ERC 98
Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion
• Jay, Lee, Goldsmith, Battat, Maurer and Suner, 2003. CPR
effectiveness in microgravity: Comparisons of thee positions and a
mechanical device. Aviat Space Environ Med, 74(11): 1183-9

Measure ER Hand Rev Bear ERC 98

Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion

Measure ER Hand Rev Bear ERC 98

Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion

Measure ER Hand Rev Bear ERC 98

Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion

Measure ER Hand Rev Bear ERC 98

Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion

Measure ER Hand Rev Bear ERC 98

Stand Hug Guidelines

Chest Comp 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50

Depth (mm)

Chest Comp Rate 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100
(per min)

Tidal Volume 491 ± 50.4 - - 400 - 600

(ml)
 Discussion
 Effectiveness of the ER method for all
populations will need to be ascertained before
it can be considered a viable method for
universal use.
 Discussion
 Effectiveness of the ER method for all
populations will need to be ascertained before
it can be considered a viable method for
universal use.
– Strength
– Anthropometric indices
– Cardiovascular fitness
 Discussion
 Effectiveness of the ER method for all
populations will need to be ascertained before
it can be considered a viable method for
universal use.
– Strength
– Anthropometric indices
– Cardiovascular fitness
 Indications are that ER CPR should be
possible for almost anyone, anywhere off
planet.
 Conclusion
 Non-terrestrial CPR - will one size fit all?
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
• Large habitat, no immediate access to equipment
and requirement to conduct CPR for mins not ER CPR
secs.
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
• Large habitat, no immediate access to equipment
and requirement to conduct CPR for mins not ER CPR
secs.
• Large habitat, access to appropriate equipment Assisted
e.g. CPR assist band, compression assist device. methods
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
• Large habitat, no immediate access to equipment
and requirement to conduct CPR for mins not ER CPR
secs.
• Large habitat, access to appropriate equipment Assisted
e.g. CPR assist band, compression assist device. methods
• Small habitat, no immediate access to equipment
and requirement to conduct CPR for hours not HS CPR
mins.
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
– On planet (within habitat).
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
– On planet (within habitat).
Conventional
• Gravity greater than +0.5Gz.
CPR ?
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
– On planet (within habitat).
Conventional
• Gravity greater than +0.5Gz.
CPR ?
• Gravity less than +0.5Gz, large habitat,
no immediate access to equipment. ER CPR
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
– On planet (within habitat).
Conventional
• Gravity greater than +0.5Gz.
CPR ?
• Gravity less than +0.5Gz, large habitat,
no immediate access to equipment. ER CPR
• Gravity less than +0.5Gz, large habitat, Assisted
access to appropriate equipment. methods
 Conclusion
 Non-terrestrial CPR - will one size fit all?
– Off planet (no artificial gravity).
– On planet (within habitat).
Conventional
• Gravity greater than +0.5Gz.
CPR ?
• Gravity less than +0.5Gz, large habitat,
no immediate access to equipment. ER CPR
• Gravity less than +0.5Gz, large habitat, Assisted
access to appropriate equipment. methods
• Gravity less than +0.5Gz, small habitat, no
immediate access to equipment, CPR HS CPR
required for hours not mins.
 Conclusion
Conventional Assisted
ER CPR methods HS CPR
CPR

 Train in multiple CPR techniques?

 Conclusion
Conventional Assisted
ER CPR methods HS CPR
CPR

 Train in multiple CPR techniques?

 Mission oriented training.
 Conclusion
Conventional Assisted
ER CPR methods HS CPR
CPR

 Train in multiple CPR techniques?

 Mission oriented training.
– CPR techniques appropriate for habitat and risks
according to mission tasks.
 Conclusion
Conventional Assisted
ER CPR methods HS CPR
CPR

 Train in multiple CPR techniques?

 Mission oriented training.
– CPR techniques appropriate for habitat and risks
according to mission tasks.
 Foreseeable future will probably require 1 or
2 methods to be learnt for each mission.
Thank you for your time

Any questions?
 E-mail address
simon.n.evetts@kcl.ac.uk