Komorowski Matthieu, Fleming Sarah
Department of Bioengineering, Imperial College London, London, SW7 2AZ UK.
University of Leicester, Maurice Shock Building, University Rd, Leicester, LE1 9HN UK.
Extrem Physiol Med. 2015 Nov 1;4:19. doi: 10.1186/s13728-015-0038-5. eCollection 2015.
The question of the safety of anaesthetic procedures performed by non anaesthetists or even by non physicians has long been debated. We explore here this question in the hypothetical context of an exploration mission to Mars. During future interplanetary space missions, the risk of medical conditions requiring surgery and anaesthetic techniques will be significant. On Earth, anaesthesia is generally performed by well accustomed personnel. During exploration missions, onboard medical expertise might be lacking, or the crew doctor could become ill or injured. Telemedical assistance will not be available. In these conditions and as a last resort, personnel with limited medical training may have to perform lifesaving procedures, which could include anaesthesia and surgery. The objective of this pilot study was to test the ability for unassisted personnel with no medical training to perform oro-tracheal intubation after a rapid sequence induction on a simulated deconditioned astronaut in a Mars analogue environment. The experiment made use of a hybrid simulation model, in which the injured astronaut was represented by a torso manikin, whose vital signs and hemodynamic status were emulated using a patient simulator software. Only assisted by an interactive computer tool (PowerPoint(®) presentation), five participants with no previous medical training completed a simplified induction of general anaesthesia with intubation.
No major complication occurred during the simulated trials, namely no cardiac arrest, no hypoxia, no cardiovascular collapse and no failure to intubate. The study design was able to reproduce many of the constraints of a space exploration mission.
Unassisted personnel with minimal medical training and familiarization with the equipment may be able to perform advanced medical care in a safe and efficient manner. Further studies integrating this protocol into a complete anaesthetic and surgical scenario will provide valuable input in designing health support systems for space exploration missions.
由非麻醉医生甚至非医生进行麻醉操作的安全性问题长期以来一直存在争议。我们在此探讨在火星探索任务这一假设背景下的该问题。在未来的星际太空任务中，出现需要手术和麻醉技术的医疗状况的风险将很大。在地球上，麻醉通常由经验丰富的人员进行。在探索任务中，可能缺乏机载医疗专业知识，或者随队医生可能生病或受伤。远程医疗援助也无法提供。在这些情况下，作为最后的手段，接受过有限医学培训的人员可能不得不实施救生程序，这可能包括麻醉和手术。这项试点研究的目的是测试在火星模拟环境中，未经医学培训的无辅助人员在快速顺序诱导后对模拟失健宇航员进行口气管插管的能力。该实验使用了一种混合模拟模型，其中受伤的宇航员由一个躯干人体模型代表，其生命体征和血流动力学状态通过患者模拟器软件进行模拟。仅在一个交互式计算机工具（PowerPoint(®)演示文稿）的辅助下，五名没有医学培训经历的参与者完成了简化的全身麻醉诱导及插管操作。
在模拟试验期间未发生重大并发症，即未出现心脏骤停、低氧血症、心血管虚脱和插管失败。该研究设计能够重现太空探索任务的许多限制因素。
接受过极少医学培训且熟悉设备的无辅助人员可能能够安全、高效地实施高级医疗护理。将该方案整合到完整的麻醉和手术场景中的进一步研究，将为太空探索任务的健康支持系统设计提供有价值的参考。
