How to perform CPR in space

Maybe you’ve never considered the issue of performing cardiopulmonary resuscitation (CPR) in space but space agencies really have thought of everything.

The likelihood of cardiac arrest occurring in space remains extremely low, and will most likely be nonsurvivable due to several factors including delayed diagnosis and difficulties in immediate and secondary management. However, five separate methods for CPR in space have been described so far.

Standard side straddle (STD) method

The rescuer places himself sideways and the patient is situated on the crew medical restraint system (the foldable stretcher of the ISS) for CPR.

Waist straddling manoeuvre (SM)

The rescuer straddles the patient’s waist, with the patient situated on the crew medical restraint system for CPR.

Reverse Bear Hug (RBH) method

The rescuer grips the patient from the back with both arms and performs chest compressions.

Evetts-Russomano (ER) method

The rescuer places himself on top of the patient, with his left leg over the right shoulder of the patient and his right leg around the patient’s back under the left arm.

Handstad (HS) method

The rescuer places his feet on one wall of the cabin with the patient’s back against the opposite wall.

It remains unclear which of these techniques could provide the best quality CPR in space. Regarding the depth of the compression, no technique achieved the requirements of the guidelines. The Handstad method appears to have an advantage over the other techniques. Although the Reverse Bear Hug method achieved also a good compression depth, this method showed up distinct disadvantages in the compressions rate.

Since the quality and performance of CPR in microgravity is lower compared to earth, mechanical CPR devices during spaceflights could improve quality.

In the last photo, ESA astronaut Paolo Nespoli practices life-saving cardiopulmonary resuscitation skills onboard the International Space Station. Two Space Station crewmembers are assigned as Crew Medical Officers and are trained to provide medical support during their mission.

Tommaso Scquizzato
Tommaso Scquizzato

Tommaso Scquizzato is a researcher in the fields of cardiac arrest and resuscitation science at the Center for Intensive Care and Anesthesiology of San Raffaele Hospital in Milan, Italy. He is the Social Media Editor of Resuscitation, member of the Social Media Working Group of ILCOR, and member of the ERC BLS Science and Education Committee.

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