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(1) Background: Cardiopulmonary resuscitation (CPR), as a form of basic life support, is critical for maintaining cardiac and cerebral perfusion during cardiac arrest, a medical condition with high expected mortality. Current guidelines emphasize the importance of rapid recognition and prompt initiation of high-quality CPR, including appropriate cardiac compression depth and rate. As space agencies plan missions to the Moon or even to explore Mars, the duration of missions will increase and with it the chance of life-threatening conditions requiring CPR. The objective of this review was to examine the effectiveness and feasibility of chest compressions as part of CPR following current terrestrial guidelines under hypogravity conditions such as those encountered on planetary or lunar surfaces; (2) Methods: A systematic literature search was conducted by two independent reviewers (PubMed, Cochrane Register of Controlled Trials, ResearchGate, National Aeronautics and Space Administration (NASA)). Only controlled trials conducting CPR following guidelines from 2010 and after with advised compression depths of 50 mm and above were included; (3) Results: Four different publications were identified. All studies examined CPR feasibility in 0.38 G simulating the gravitational force on Mars. Two studies also simulated hypogravity on the Moon with a force of 0.17 G/0,16 G. All CPR protocols consisted of chest compressions only without ventilation. A compression rate above 100/s could be maintained in all studies and hypogravity conditions. Two studies showed a significant reduction of compression depth in 0.38 G (−7.2 mm/−8.71 mm) and 0.17 G (−12.6 mm/−9.85 mm), respectively, with nearly similar heart rates, compared to 1 G conditions. In the other two studies, participants with higher body weight could maintain a nearly adequate mean depth while effort measured by heart rate (+23/+13.85 bpm) and VO2max (+5.4 mL·kg−1·min−1) increased significantly; (4) Conclusions: Adequate CPR quality in hypogravity can only be achieved under increased physical stress to compensate for functional weight loss. Without this extra effort, the depth of compression quickly falls below the guideline level, especially for light-weight rescuers. This means faster fatigue during resuscitation and the need for more frequent changes of the resuscitator than advised in terrestrial guidelines. Alternative techniques in the straddling position should be further investigated in hypogravity.

We present this case of a young woman with SARS-CoV-2 viral infection resulting in coronavirus 2019 (COVID-19) lung disease complicated by a complex hydropneumothorax, recurrent pneumothorax, and pneumatoceles. A 33-year-old woman presented to the hospital with a one-week history of cough, shortness of breath, and myalgia, with no other significant past medical history. She tested positive for COVID-19 and subsequently, her respiratory function rapidly deteriorated, necessitating endotracheal intubation and mechanical ventilation. She had severe hypoxic respiratory failure requiring a protracted period on the mechanical ventilator with different ventilation strategies and multiple cycles of prone positioning. During her proning, after two weeks on the intensive care unit, she developed tension pneumothorax that required bilateral intercostal chest drains (ICD) to stabilise her. After 24 days, she had a percutaneous tracheostomy and began her respiratory wean; however, this was limited due to the ongoing infection. Thorax CT demonstrated a left-sided pneumothorax, with bilateral pneumatoceles and a sizeable, complex hydropneumothorax. Despite the insertion of ICDs, the hydropneumothorax persisted over months and initially progressed in size on serial scans needing multiple ICDs. She was too ill for surgical interventions initially, opting for conservative management. After 60 days, she successfully underwent a video-assisted thoracoscopic surgery (VATS) for a washout and placement of further ICDs. She was successfully decannulated after 109 days on the intensive care unit and was discharged to a rehabilitation unit after 116 days of being an inpatient, with her last thorax CT showing some residual pneumatoceles but significant improvement. Late changes may mean patients recovering from the COVID-19 infection are at increased risk of pneumothoracies. Clinicians need to be alert to this, especially as bullous rupture may not present as a classical pneumothorax.

BackgroundScalp lacerations are a common presentation to the Emergency Department (ED). The Hair Apposition Technique (HAT) is a safe, effective, efficient and patient-centred alternative to sutures and commonly used in paediatrics. This Quality Improvement Project (QIP) was inspired by a patient with dementia who could not tolerate sutures for her scalp laceration therefore HAT was used with excellent results and patient satisfaction. This project aimed to introduce the technique to 50% of all eligible adult patients within 6 months.Method and resultsA retrospective, case-note baseline review demonstrated no use of HAT in adults during a period of three months. Barrier analysis using staff surveys explored why HAT was not standard practice. We introduced HAT using the Institute of Healthcare Improvement (IHI)’s Model for improvement methodology and conducted four Plan, Do, See, Act (PDSA) cycles to implement changes. Our process measure was the number of patients having HAT compared with sutures. Outcome measures were via a qualitative phone survey evaluating pain, satisfaction and inconvenience score on a scale of 0–10. Balancing measures included wound complication and re-attendance.ConclusionsDuring the 6 months following the introduction of HAT 71% patients who were eligible to have HAT had the technique instead of sutures or staples, with improvement in all patient outcome measures compared with those who had sutures. HAT was popular with staff and patients. Our sustainability review at one year showed ongoing use of the technique and we have achieved a significant culture change by establishing the technique as standard practice for adults.Abstract 037 Table 1Breakdown of head lacerations and their closure by month comparing a 3-month period, one year apartAbstract 037 Figure 1Graph to show impact of PDSA Cycles on the No. of Patients Having Either Sutures/Staples vs. HAT Over TimeAbstract 037 Figure 2Run chart comparing the Baseline results with HAT for Pain scoresConclusionHAT should be considered in eligible adult patients with scalp lacerations presenting to the ED. Applying quality improvement methodology resulted in a sustained culture change; the ED involved now offers an effective suture free paediatric technique to adults which has improved patient outcomes and satisfaction.

INTRODUCTION Cardiopulmonary resuscitation (CPR) in microgravity is challenging. There are three single-person CPR techniques that can be performed in microgravity: the Evetts-Russomano (ER), Handstand (HS), and Reverse Bear Hug (RBH). All three methods have been evaluated in parabolic flights, but only the ER method has been shown to be effective in prolonged microgravity simulation. All three methods of CPR have yet to be evaluated using the current 2010 guidelines. METHODS There were 23 male subjects who were recruited to perform simulated terrestrial CPR (+1 G(z)) and the three microgravity CPR methods for four sets of external chest compressions (ECC). To simulate microgravity, the subjects used a body suspension device (BSD) and trolley system. True depth (D(T)), ECC rate, and oxygen consumption (Vo2) were measured. RESULTS The mean (+/- SD) D(T) for the ER (37.4 +/- 1.5 mm) and RBH methods (23.9 +/- 1.4 mm) were significantly lower than +1 G(z) CPR. However, both methods attained an ECC rate that met the guidelines (105.6 +/- 0.8; 101.3 +/- 1.5 compressions/min). The HS method achieved a superior D(T) (49.3 +/- 1.2 mm), but a poor ECC rate (91.9 +/- 2.2 compressions/min). Vo2 for ER and HS was higher than +1 Gz; however, the RBH was not. CONCLUSION All three methods have merit in performing ECC in simulated microgravity; the ER and RBH have adequate ECC rates, and the HS method has adequate D(T). However, all methods failed to meet all criteria for the 2010 guidelines. Further research to evaluate the most effective method of CPR in microgravity is needed.

BACKGROUND: This original study evaluated the electromyograph (EMG) activity of four upper body muscles: triceps brachii, erector spinae, upper rectus abdominis, and pectoralis major, while external chest compressions (ECCs) were performed in simulated Martian hypogravity using a Body Suspension Device, counterweight system, and standard full body cardiopulmonary resuscitation (CPR) mannequin. METHOD: 20 young, healthy male subjects were recruited. One hundred compressions divided into four sets, with roughly six seconds between each set to indicate ‘ventilation’, were performed within approximately a 1.5 minute protocol. Chest compression rate, depth and number were measured along with the subject's heart rate (HR) and rating of perceived exertion (RPE). RESULTS: All mean values were used in two-tailed t-tests using SPSS to compare +1 Gz values (control) versus simulated hypogravity values. The AHA (2005) compression standards were maintained in hypogravity. RPE and HR increased by 32% ( p 0.001 ) and 44% ( p = 0.002 ), respectively, when ECCs were performed during Mars simulation, in comparison to +1 Gz. In hypogravity, the triceps brachii showed significantly less activity ( p 0.001 ) when compared with the other three muscles studied. The comparison of all the other muscles showed no difference at +1 Gz or in hypogravity. CONCLUSIONS: This study was among the first of its kind, however several limitations were faced which hopefully will not exist in future studies. Evaluation of a great number of muscles will allow space crews to focus on specific strengthening exercises within their current training regimes in case of a serious cardiac event in hypogravity.

Performance of efficient single-person cardiopulmonary resuscitation (CPR) is vital to maintain cardiac and cerebral perfusion during the 2–4 min it takes for deployment of advanced life support during a space mission. The aim of the present study was to investigate potential differences in upper body muscle activity during CPR performance at terrestrial gravity (+1Gz) and in simulated microgravity (μG). Muscle activity of the triceps brachii, erector spinae, rectus abdominis and pectoralis major was measured via superficial electromyography in 20 healthy male volunteers. Four sets of 30 external chest compressions (ECCs) were performed on a mannequin. Microgravity was simulated using a body suspension device and harness; the Evetts–Russomano (ER) method was adopted for CPR performance in simulated microgravity. Heart rate and perceived exertion via Borg scores were also measured. While a significantly lower depth of ECCs was observed in simulated microgravity, compared with +1Gz, it was still within the target range of 40–50 mm. There was a 7.7% decrease of the mean (±SEM) ECC depth from 48 ± 0.3 mm at +1Gz, to 44.3 ± 0.5 mm during microgravity simulation (p

A 49-year-old man presented to the accident and emergency department, with a short history of vague abdominal pain, abdominal distension and two episodes of frank haematuria. A plain chest film showed dilated loops of large bowel and blood results on admission showed an acute kidney injury (stage 3). A diagnosis of bowel obstruction was made initially but a CT scan of the abdomen showed bilateral obstructing calculi. After initial resuscitation, the patient had bilateral ultrasound-guided nephrostomies and haemofiltration. He later underwent bilateral antegrade ureteric stenting. A decision will later be made on whether or not he is fit enough to undergo ureteroscopy and laser stone fragmentation.

Background If a cardiac arrest occurs in microgravity, current emergency protocols aim to treat patients via a medical restraint system within 2-4 min. It is vital that crewmembers have the ability to perform single-person cardiopulmonary resuscitation (CPR) during this period, allowing time for advanced life support to be deployed. The efficacy of the Evetts-Russomano (ER) method has been tested in 22 s of microgravity in a parabolic flight and has shown that external chest compressions (ECC) and mouth-to-mouth ventilation are possible. Methods There were 21 male subjects who performed both the ER method in simulated microgravity via full body suspension and at +1 Gz. The CPR mannequin was modified to provide accurate readings for ECC depth and a metronome to set the rate at 100 bpm. Heart rate, rate of perceived exertion, and angle of arm flexion were measured with an ECG, elbow electrogoniometers, and Borg scale, respectively. Results The mean (+/- SD) depth of ECC in simulated microgravity was lower in each of the 3 min compared to +1 G2. The ECC depth (45.7 +/- 2.7 mm, 42.3 +/- 5.5 mm, and 41.4 +/- 5.9 mm) and rate (104.5 +/- 5.2, 105.2 +/- 4.5, and 102.4 +/- 6.6 compressions/min), however, remained within CPR guidelines during simulated microgravity over the 3-min period. Heart rate, perceived exertion, and elbow flexion of both arms increased using the ER method. Conclusion The ER method can provide adequate depth and rate of ECC in simulated microgravity for 3 min to allow time to deploy a medical restraint system. There is, however, a physiological cost associated with it and a need to use the flexion of the arms to compensate for the lack of weight.

Introduction: Studies were conducted to evaluate cardiopulmonary resuscitation (CPR) in a simulated low gravitational field, such as Mars (hypoG), aimed at providing an insight into the performance of terrestrial CPR. Methods: Two studies were conducted to evaluate external chest compressions (ECC) depth and rate, as well as perceived exertion (RPE) and the physiological cost, when 4 sets of 30 ECCs were performed on a standard CPR mannequin for 1.5min during Mars simulation, using terrestrial (1Gz) as control. The first study (n=20; 2005 guidelines) also evaluated the electromyographic (EMG) activity of four muscles (triceps brachii, erector spinae, upper rectus abdominis, pectoralis major). The second study (n=30; 2010 guidelines) included range of elbow flexion, minute ventilation (VE) and peak oxygen consumption (VO2 peak) measurements. HypoG simulation was achieved using a body suspension device (BSD) and a counterweight system. Results: In both studies, subjects successfully performed ECCs at 1Gz and hypoG. In the first study, therewere increases from 1Gz values of 32% (p