Evaluation of a novel method of performing cardiopulmonary resuscitation in microgravity

1. Evaluation of a novel method of performing cardiopulmonary resuscitation in microgravity Simon N Evetts PhD, Lisa Evetts RGN, Thais Russomano MD PhD, João Castro MD and John Ernsting MBBS PhD. Microgravity Laboratory, PUCRS, Porto Alegre, Brazil. Human Physiology and Aerospace Medicine Group, King’s College London.

2. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet?

3. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? • Current unrestrained Basic Life Support methods, i.e. unaided, single person CPR.

4. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? • Current unrestrained Basic Life Support methods, i.e. unaided, single person CPR. • Hand stand method

5. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? • Current unrestrained Basic Life Support methods, i.e. unaided, single person CPR. • Hand stand method • Reverse bear-hug (Heimlich).

6. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? • Current unrestrained Basic Life Support methods, i.e. unaided, single person CPR. • Hand stand method • Reverse bear-hug (Heimlich). • Limitations.

7. Background • Can Cardiopulmonary Resuscitation be performed by anyone, anywhere when off planet? • Current unrestrained Basic Life Support methods, i.e. unaided, single person CPR. • 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?

8. Aim The aim of the study was to ascertain the viability and effectiveness of performing a new method of unaided, single person CPR in microgravity.

9. Recent and current CPR guidelines • 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.

10. Recent and current CPR guidelines • 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.

11. ER CPR method – chest compression potential.

12. ER method – ventilation potential.

13. Manikin trials. • 4  2 Subjects/investigators. • Laerdal adapted CPR manikin

14. Manikin trials. • Pre & post flight +1Gz measures.

15. Measure +1GZ Microgravity Results 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 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

16. Measure +1GZ Microgravity Results 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 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

17. Measure +1GZ Microgravity Results 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 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

18. Measure +1GZ Microgravity Results 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 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

19. Measure +1GZ Microgravity Results 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 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

20. Discussion • Reasons for insufficient rate of chest compression and greater variation of measures in microgravity.

21. Discussion • Reasons for insufficient rate of chest compression and greater variation of measures in microgravity. • Novelty of environment.

22. 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.

23. 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).

24. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600 • ER compared to other methods of performing CPR in microgravity.

25. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600 • 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

26. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600

27. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600

28. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600

29. Measure ER Hand Stand Rev Bear Hug ERC 98 Guidelines Discussion Chest Comp Depth (mm) 41.3 ± 1.03 40.1 ± 0.51 36.8 ± 0.64 40 – 50 Chest Comp Rate (per min) 80.2 ± 3.4 98.3 ± 6.3 89.3 ± 4.1 ~ 100 Tidal Volume (ml) 491 ± 50.4 - - 400 - 600

30. Recommendations and Conclusion • Effectiveness of the ER method for all populations will need to be ascertained before it can be considered a viable method for universal use.

31. Recommendations and Conclusion • 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 indeces • Cardiovascular fitness

32. Recommendations and Conclusion • 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 indeces • Cardiovascular fitness • Indications are that ER CPR should be possible for almost anyone, anywhere off planet.

33. Thank you for your timeAny questions?

34. Our thanks to:-Laerdal Uk LtdVARIG E-mail address snevetts@btopenworld.com or simon.evetts@kcl.ac.uk