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br Future potential cardiac examinations for
Future potential cardiac examinations for long-duration spaceflights
Currently available treatments for emergency cases in spaceflight
Astronaut Crew Medical Officers (CMO) aboard the ISS receive 40–70h of medical training, including CPR training, within 18 months preceding their mission (Fig. 8). However, opportunities for crew to refresh their knowledge of CPR training in flight are limited, because of the busy time schedule. Therefore, compliance with the CPR guidelines may be uncertain [57]. Astronauts need to take more courses that are intensive in CPR so that it becomes second nature to them. If they do not have enough training, it could become a NCT-501 Supplier of life or death in an emergency case on the ISS.
NASA and the Russian Federal Space Agency each supply medical equipment for the ISS. NASA\'s medical apparatus is called the crew health care system (CHeCS). The Health Maintenance System (HMS) is one part of the CHeCS. It is an in-flight preventive medical system that can diagnose and treat patients. It can also be used to treat severe disease on the ISS [58]. The HMS division maintains the crews\' health by using various packs in the ISS from the CHeCS rack. The HMS is divided into 6 sections as follows [59].
Treatment of fatal arrhythmias in hospitals today
In 1891, Dr. Friedrich Maass issued the first documented research concerning chest compressions for humans. The American Heart Association (AHA) formally subscribed to CPR in 1963 and published standardized guidelines for its instruction in 1966 [60]. ACLS guidelines have changed over the decades, based on a combination of scientific evidence and expert consensus. For example, the AHA developed the most recent ACLS guidelines in 2010 by using a comprehensive review of the resuscitation literature. The guidelines are reviewed continually and formally released every 5 years. The AHA Guidelines were reviewed in 2010. Excellent CPR and early defibrillation for fatal arrhythmias, like VF and VT, are the first steps of BTLS and ACLS. The new Guidelines for ACLS emphasize that chest compressions should be effective and continuous in order to achieve adequate cerebral and coronary perfusion. The 2010 ACLS Guidelines strongly recommend that every effort be made not to interrupt CPR [60]. These changes should be included in the CMO training. Although the ISS tries to follow the AHA Guidelines, Incompatibility falls short in many areas—drugs (amiodarone), exhaled CO2 detectors, etc. (Table 2) [58].
Comparisons between ISS treatments and hospital treatments
Fortunately, crewmembers of the ISS have never experienced an emergency that required ACLS. ISS crewmember candidates are required to receive training in BLTS and ACLS before they go on a mission; however, microgravity produces many conditions that are different from Earth. For example, a bubble in a bag of normal saline does not disappear to the “top of the bag” in microgravity. Intravenous drip bags have to be squeezed by placing the bag in a blood pressure cuff with a pressure of 50–70mmHg [58]. Moreover, whereas doctors in the emergency room can use a video laryngoscope for endotracheal intubation and exhaled CO2 detectors to prevent esophageal intubation, the crewmembers in the ISS must perform endotracheal intubation by using the old laryngoscopic method without exhaled CO2 detectors, which may result in esophageal intubation. There are two reasons why the crewmembers cannot use CO2 detectors. First, it is difficult to read the colorimetric end-tidal CO2 in the low ambient light of the ISS [58]. Second, the results of the colorimetric end-tidal CO2 are not reliable because the CO2 level in the ISS is higher than that at ground level. For the above reasons, an esophageal detector bulb is provided in the ISS [58].
In the ISS, due to packing and storage issues, there are just three drugs (epinephrine, lidocaine, and atropine) for ACLS compared to the dozen or so drugs available to emergency room doctors. This is not nearly enough [58]. As new evidence for drug use with ACLS has accumulated, the revised ACLS guidelines state: “Atropine is no longer recommended for routine use and has been removed from the cardiac arrest algorithm.” On the other hand, recent studies showed amiodarone could be a key drug for treating cardiac arrest, especially in VF and VT [61]. It may be an effective countermeasure for fatal arrhythmias to provide amiodarone in the ISS, instead of atropine.