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Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review

Published online by Cambridge University Press:  29 August 2019

Craig D. Nowadly ,
Brandon D. Trapp ,
Stephen K. Robinson  and
John R. Richards Open the ORCID record for John R. Richards [Opens in a new window]
Craig D. Nowadly*
Affiliation:
Department of Emergency Medicine, David Grant United States Air Force Medical Center, Travis Air Force Base, CaliforniaUSA Department of Emergency Medicine, University of California at Davis, Medical Center, Sacramento, CaliforniaUSA
Brandon D. Trapp
Affiliation:
Department of Emergency Medicine, University of California at Davis, Medical Center, Sacramento, CaliforniaUSA
Stephen K. Robinson
Affiliation:
Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CaliforniaUSA
John R. Richards
Affiliation:
Department of Emergency Medicine, University of California at Davis, Medical Center, Sacramento, CaliforniaUSA
*
Correspondence: Craig D. Nowadly, MD Department of Emergency Medicine PSSB 2100, U.C. Davis Medical Center 4150 V Street Sacramento, California 95817 USA E-mail: cdnowadly@ucdavis.edu
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Abstract

Introduction:

Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.

Methods:

PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.

Results:

The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles.

Discussion:

The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.

Keywords

Advanced Life Supportastronautcritical careemergency medicineevacuationInternational Space Stationlow Earth orbitresuscitationspace ambulance
Type
Comprehensive Review
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 5 , October 2019 , pp. 521 - 531
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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