Gap ExMC 4.10: Lack of rapid vascular access capability for space flight (CLOSED)
Last Published:  07/30/21 01:05:31 PM (Central)
Responsible Element: Exploration Medical Capability (ExMC)
Status: Closed
Closure Rationale

Gap Closure Synopsis
To date, there has never been a medical
need to gain immediate vascular access in space; however, intravenous (IV) fluids have been administered during space flight via various methods (IV cannulas, PICC lines). Earlier missions aboard the International Space Station (ISS) had as
tronaut crew medical officers (CMO) using one method for establishing vascular access during space flight. The techniques for this method were relatively slow and cumbersome, even in trained clinical hands. In 2007, the JSC Medical Operations Board (MOB) believed these techniques would be problematic in urgent medical situations and, thus, impact care for the crew. A method for rapid IV access that could be used effectively and safely by the astronaut cohort could mitigate this concern, especially for exploration class missions. This gap was established to identify, evaluate, and integrate any system that would allow minimally trained CMOs to successfully and safely complete rapid IV access.

The technique of intraosseous (IO) infusion had regained popularity as being one of the quickest ways to establish IV access for emergent and non-emergent situations. The procedure takes advantage of the fact that the marrow cavity in bones is in continuity with the venous circulation and can therefore be used to infuse fluids and drugs as well as take blood samples.  Briefly, the caregiver inserts a needle near the tibial tuberosity at the top of the lower leg (top of the tibia bone, below the knee) to establish IV access. This procedure can also be performed at the base of the tibia (top of ankle) and at the top of the humerus (shoulder). Evidence from published reports and an evaluation by ExMC and MOB regarding IO devices has been documented in both the NASA Memorandum “C-9 and Other Microgravity Simulations” (NASA/TM-2007-214765) and the Aerospace Medical Association Presentation “Evaluation of Intraosseous (IO) Devices as Possible Adjunct to Intravenous Drug Administration during Space Flight” (Aviation Space and Environmental Medicine 79(3):129 2008). These data provide sufficient closure to this gap by 1) identifying and evaluating several rapid access IO systems and 2) demonstrating that such systems can be used effectively and safely by CMO analogs in a microgravity environment.

Rationale for Closure

ExMC’s evaluation of the IO systems led to recommendations being submitted to the MOB for their review. The MOB (which is now called the JSC Medical Operations Group (MOG)) selected a system to be validated and integrated into the ISS Health Maintenance System (HMS). An IO system has been integrated into the ISS HMS and manifested aboard the ISS since 2012. This gap can now be considered closed because the ISS IO system is also applicable as a rapid IV access system for exploration class space missions.

Task and Supporting Reports Complete

1. C-9 and Other Microgravity Simulations, 9/1/2007.

2. Aerospace Medical Association Presentation. Evaluation of Intraosseous (IO) Devices as Possible Adjunct to Intravenous Drug Administration during Space Flight. Aviation Space and Environmental Medicine 79(3):129 2008.


Description
1)  Initial State
In a medical contingency, the ability to gain access to the patient's vascular system to provide medications or fluid can be critical. However, the current techniques for rapidly gaining access require training and skill that cannot be afforded to the Crew Medical Officers (CMO's). This gap is focused on finding technologies or techniques that can allow a minimally trained care provider to safely and rapidly establish vascular access in a patient. This assessment will consider intravenous (IV), intraosseous (IO) and intramuscular (IM) vascular access methods as potential treatment modalities.

Target for Closure
No Target for Closure available.
Mappings
Risk Risk of Adverse Health Outcomes and Decrements in Performance Due to Medical Conditions that occur in Mission, as well as Long Term Health Outcomes Due to Mission Exposures
You are here! Gap ExMC 4.10: Lack of rapid vascular access capability for space flight (CLOSED)
Completed

Multi-Disciplinary Research Plans

Documentation:
No Documentation Available