Download PDF
Flugmedizin · Tropenmedizin · Reisemedizin - FTR 2018; 25(05): 213-218
DOI: 10.1055/a-0749-6868
Raumfahrtmedizin
Georg Thieme Verlag KG Stuttgart · New York

Medizinische Versorgung bei Langzeitmissionen in der Raumfahrt

Medical care on long-term missions in space flight
Steffen Kerkhoff
1   Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR)
2   AG „Notfallmedizin und Luftrettung“, Deutsche Gesellschaft für Luft- und Raumfahrtmedizin (DGLRM) e. V., München
3   Space Medicine Group der European Society of Aerospace Medicine, Köln
,
Matthieu Komorowski
4   Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
5   Space Medicine Team, ISS Operations and Astronauts Group, European Astronaut Centre, European Space Agency, Köln
,
Jan Schmitz
1   Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR)
2   AG „Notfallmedizin und Luftrettung“, Deutsche Gesellschaft für Luft- und Raumfahrtmedizin (DGLRM) e. V., München
3   Space Medicine Group der European Society of Aerospace Medicine, Köln
,
Stefanie Jansen
6   Klinik und Poliklinik für Hals- Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Köln (AöR)
,
Moritz F. Meyer
6   Klinik und Poliklinik für Hals- Nasen- und Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Köln (AöR)
,
Tobias Warnecke
7   Evangelisches Klinikum Niederrhein, Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Duisburg
,
Jochen Hinkelbein
1   Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR)
2   AG „Notfallmedizin und Luftrettung“, Deutsche Gesellschaft für Luft- und Raumfahrtmedizin (DGLRM) e. V., München
3   Space Medicine Group der European Society of Aerospace Medicine, Köln
› Author Affiliations
Further Information

Publication History

Publication Date:
30 October 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Im Lichte zukünftiger Langzeitraumfahrtmissionen fernab der Erdumlaufbahn besitzt die Fähigkeit der Crew zur autonomen, medizinischen Versorgung einen besonderen Stellenwert. Hier ist insbesondere die Durchführung einer Anästhesie bei einer dringend notwendigen Operation von entscheidender Bedeutung, um unter Umständen die Mission weiter fortsetzen zu können. Bisher musste noch keine Allgemeinanästhesie in der Raumfahrt durchgeführt werden, sodass die praktische Erfahrung entsprechend limitiert ist. Es erscheint sinnvoll, in Umgebungen mit vergleichbaren medizinischen Versorgungssituationen nach Erfahrungswerten und Behandlungsstrategien zu suchen. Diese Umgebungen sollten über eine oder mehrere der Eigenschaften von Raumfahrtmissionen verfügen. Beispielsweise könnten dies Limitationen bei medizinischem Personal und Ausstattung oder die Unmöglichkeit einer zeitnahen Evakuierung zu einer höherwertigen Versorgungseinrichtung sein. Die vorliegende Übersichtsarbeit fasst die bisher zu diesem Thema publizierte Literatur zusammen und gibt einen Überblick über wichtige und bisher bekannte medizinische Maßnahmen in Schwerelosigkeit.

Abstract

In light of future space exploration missions far away from low-earth orbit, the crew needs to be able to perform medical care fully self-sufficient. Therefore, the ability to provide safe anesthesia for urgent operations represents a crucial step to ensure mission continuation. So far, surgery has never been performed in space under microgravity. Thus, there is no practical experience with the provision of anesthesia during spaceflight. Therefore, it is important to look at environments with similar properties and at the way anesthesia is handled there. Those environments should, at least, possess one of the essential characteristics of space exploration missions, like for example limitations in medical qualified personnel, medical equipment or the ability to evacuate patients to a hospital. This review summarizes the available literature and gives an overview concerning the provision of anesthesia under spaceflight conditions.

Key words

anesthesia - space flight - surgery - emergency medicine - microgravity
 

  • Literatur

  • 1 Rogozov V, Bermel N. Auto-appendectomy in the Antarctic: case report.. BMJ 2009; 339: b4965
    CrossrefPubMedGoogle Scholar
  • 2 Reynolds RJ, Day SM. The effect of competing risks on astronaut and cosmonaut mortality.. Life Sci Space Res (Amst) 2018; 18: 35-41
    PubMedGoogle Scholar
  • 3 Barratt MR, Pool SL. Eds Principles of Clinical Medicine for Space Flight.. Springer. New York: 2008
    PubMedGoogle Scholar
  • 4 The World Bank. World Bank Country and Lending Groups. Im Internet: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
  • 5 World Health Organization. WHO Guidelines for Safe Surgery 2009. Im Internet: http://whqlibdoc.who.int/publications/2009/9789241598552_eng.pdf
  • 6 Eastridge BJ, Mabry RL, Seguin P. et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care.. J Trauma Acute Care Surg 2012; 73 (06) (Suppl. 05) S431-S437
    CrossrefPubMedGoogle Scholar
  • 7 Butler Jr FK, Blackbourne LH. Battlefield trauma care then and now: a decade of Tactical Combat Casualty Care.. J Trauma Acute Care Surg 2012; 73 (Suppl. 65) S395-S402
    CrossrefPubMedGoogle Scholar
  • 8 Maddry JK, Perez CA, Mora AG. et al. Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study.. Mil Med Res 2018; 5: 22
    PubMedGoogle Scholar
  • 9 Imray CH, Grocott MP, Wilson MH. et al. Extreme, expedition, and wilderness medicine.. Lancet 2015; 386: 2520-2525
    CrossrefPubMedGoogle Scholar
  • 10 Aaen-Larsen B. Health care in the circumpolar world: Greenland.. Int J Circumpolar Health 2004; 63 (Suppl. 02) 49-53
    PubMedGoogle Scholar
  • 11 Grant IC. Telemedicine in the British Antarctic survey.. Int J Circumpolar Health 2004; 63: 356-364
    CrossrefPubMedGoogle Scholar
  • 12 World Bank Group. Disease Control Priorities, Third Edition (Volume 1): Essential Surgery. 2015. Im Internet: http://elibrary.worldbank.org/doi/book/10.1596/978-1-4648-0346-8
  • 13 Berry I, Berthier A, Marescaux J. et al. Necessary Biomedical Technologies For Crew Health Control During Long-Duration Interplanetary Manned Missions.. ESTEC 2002
    PubMedGoogle Scholar
  • 14 Smith SM, Heer M, Shackelford LC. et al. Bone metabolism and renal stone risk during International Space Station missions.. Bone 2015; 81: 712-720
    CrossrefPubMedGoogle Scholar
  • 15 Mermel LA. Infection prevention and control during prolonged human space travel.. Clin Infect Dis 2013; 56: 123-130
    CrossrefPubMedGoogle Scholar
  • 16 Ball CG, Kirkpatrick AW, Williams DR. et al. Prophylactic surgery prior to extended-duration space flight: is the benefit worth the risk?. Can J Surg 2012; 55: 125-131
    CrossrefPubMedGoogle Scholar
  • 17 Martin J, Tau G, Cherian MN. et al. Survey of the capacity for essential surgery and anaesthesia services in Papua New Guinea.. BMJ Open 2015; 5: e009841
    CrossrefPubMedGoogle Scholar
  • 18 Jochberger S, Ismailova F, Lederer W. et al. Anesthesia and its allied disciplines in the developing world: a nationwide survey of the Republic of Zambia.. Anesth Analg 2008; 106: 942-948
    CrossrefPubMedGoogle Scholar
  • 19 McQueen K, Coonan T, Ottaway A. et al. The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety.. World J Surg 2015; 39: 2153-2160
    CrossrefPubMedGoogle Scholar
  • 20 Weaver SJ, Salas E. Training and Measurement at the Extremes: Developing and Sustaining Expert Team Performance in Isolated, Confined, Extreme Environments.. Proc Hum Factors Ergon Soc Annu Meet 2010; 54: 90-93
    CrossrefGoogle Scholar
  • 21 Mahoney PF. Combat Anesthesia: The First 24 Hours.. Falls Church, Virginia. Office of The Surgeon General United States Army: 2015
    PubMedGoogle Scholar
  • 22 Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research.. Mil Med 1984; 149: 55-62
    CrossrefPubMedGoogle Scholar
  • 23 Butler Jr FK , Hagmann J, Butler EG. Tactical combat casualty care in special operations.. Mil Med 1996; 161 Suppl 3-16
    CrossrefPubMedGoogle Scholar
  • 24 Butler FK, Kotwal RS, Buckenmaier CC . 3rd et al. A Triple-Option Analgesia Plan for Tactical Combat Casualty Care: TCCC Guidelines Change 13-04.. J Spec Oper Med 2014; 14: 13-25
    PubMedGoogle Scholar
  • 25 Komorowski M, Neuhaus C, Hinkelbein J. Emergency medicine in space.. Notfall Rettungsmed 2015; 18: 268-273
    CrossrefGoogle Scholar
  • 26 Stewart LH, Trunkey D, Rebagliati GS. Emergency medicine in space.. J Emerg Med 2007; 32: 45-54
    CrossrefPubMedGoogle Scholar
  • 27 Saluja IS, Williams DR, Woodard D. et al. Survey of astronaut opinions on medical crewmembers for a mission to Mars.. Acta Astronaut 2008; 63: 586-593
    CrossrefGoogle Scholar
  • 28 Komorowski M, Fleming S, Mawkin M. et al. Anaesthesia in austere environments: literature review and considerations for future space exploration missions.. NPJ Microgravity 2018; 4: 5
    CrossrefPubMedGoogle Scholar
  • 29 Kuypers MI. Emergency and wilderness medicine training for physician astronauts on exploration class missions.. Wilderness Environ Med 2013; 24: 445-449
    CrossrefPubMedGoogle Scholar
  • 30 Mehta P, Bhayani D. Impact of space environment on stability of medicines: Challenges and prospects.. J Pharm Biomed Anal 2017; 136: 111-119
    CrossrefPubMedGoogle Scholar
  • 31 Ventola CL. Medical Applications for 3D Printing: Current and Projected Uses.. P T 2014; 39: 704-711
    PubMedGoogle Scholar
  • 32 Wong JY, Pfahnl AC. 3D Printed Surgical Instruments Evaluated by a Simulated Crew of a Mars Mission.. Aerosp Med Hum Perform 2016; 87: 806-810
    PubMedGoogle Scholar
  • 33 Bowling F, Pennardt A. The use of fresh whole blood transfusions by the SOF medic for hemostatic resuscitation in the austere environment.. J Spec Oper Med 2010; 10: 25-35
    PubMedGoogle Scholar
  • 34 Nessen SC, Eastridge BJ, Cronk D. et al. Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets.. Transfusion 2013; 53 (Suppl. 01) 107S-113S
    CrossrefPubMedGoogle Scholar
  • 35 Keneally RJ, Parsons AM, Willett PB. Warm fresh whole blood and thoracic traumain iraq and afghanistan.. J Emerg Trauma Shock 2015; 8: 21-25
    CrossrefPubMedGoogle Scholar
  • 36 Otto C, Comtois JM, Sargsyan A. et al. The Martian chronicles: remotely guided diagnosis and treatment in the Arctic Circle.. Surg Endosc 2010; 24: 2170-2177
    CrossrefPubMedGoogle Scholar
  • 37 Cooke WH, Convertino VA. Cardiovascular consequences of weightlessness promote advances in clinical and trauma care.. Curr Pharm Biotechnol 2005; 6: 285-297
    CrossrefPubMedGoogle Scholar
  • 38 Gunga H-C, Ahlefeld V Weller von, Appell Coriolano H-J, Werner A, Hoffmann U. Cardiovascular System, Red Blood Cells, and Oxygen Transport in Microgravity.. Cham:: Springer International; 2016
    PubMedGoogle Scholar
  • 39 Aubert AE, Beckers F, Verheyden B. Cardiovascular function and basics of physiology in microgravity.. Acta Cardiol 2005; 60: 129-151
    CrossrefPubMedGoogle Scholar
  • 40 Schmitz J, Kerkhoff S, Braunecker S. et al. Kardiopulmonale Reanimation im Weltall.. Flug u Reisemed 2018; 25: 162-166
    Article in Thieme ConnectGoogle Scholar
  • 41 Schmitz J. Strukturelle Veränderungen des Gehirns bei einem Aufenthalt im All.. Flug u Reisemed 2018; 25: 53-54
    Article in Thieme ConnectGoogle Scholar
  • 42 Wilson MH, Hargens AR, Imray CH. Effects of Spaceflight on Astronaut Brain Structure.. N Engl J Med 2018; 378: 581
    CrossrefPubMedGoogle Scholar
  • 43 Agnew JW, Fibuch EE, Hubbard JD. Anesthesia during and after exposure to microgravity.. Aviat Space Environ Med 2004; 75: 571-580
    PubMedGoogle Scholar
  • 44 Komorowski M, Fleming S, Kirkpatrick AW. Fundamentals of Anesthesiology for Spaceflight.. J Cardiothorac Vasc Anesth 2016; 30: 781-790
    CrossrefPubMedGoogle Scholar
  • 45 Norfleet WT. Anesthetic concerns of spaceflight.. Anesthesiology 2000; 92: 1219-1222
    CrossrefPubMedGoogle Scholar
  • 46 Braunecker S, Douglas B, Hinkelbein J. Comparison of different techniques for in microgravity-a simple mathematic estimation of cardiopulmonary resuscitation quality for space environment.. Am J Emerg Med 2015; 33: 920-924
    CrossrefPubMedGoogle Scholar
  • 47 Hinkelbein J, Russomano T, Hinkelbein F. et al. Cardiac arrest during space missions: Specificities and challenges.. Trends in Anaesthesia and Critical Care 2018; 19: 6-12
    CrossrefGoogle Scholar
  • 48 Silverman GL, McCartney CJ. Regional anesthesia for the management of limb injuries in space.. Aviat Space Environ Med 2008; 79: 620-625
    CrossrefPubMedGoogle Scholar
  • 49 Komorowski M, Fleming S, Hinkelbein J. Anaesthesia in outer space: the ultimate ambulatory setting?. Curr Opin Anaesthesiol 2016; 29: 649-654
    CrossrefPubMedGoogle Scholar
  • 50 Luyet C, Schüpfer G, Wipfli M. et al. Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation.. Anesthesiol Res Pract 2010; 2010: 309462
    PubMedGoogle Scholar
  • 51 Mulvey JM, Qadri AA, Maqsood MA. Earthquake injuries and the use of ketamine for surgical procedures: the Kashmir experience.. Anaesth Intensive Care 2006; 34: 489-494
    CrossrefPubMedGoogle Scholar
  • 52 Warnecke T, Tochtermann F, Kerkhoff S. et al. Airway management in microgravity: A systematic review.. Acta Anaesthesiol Scand 2018 [Epub ahead of print]
    PubMedGoogle Scholar