- It's a familiar scenario
for all of you watching, I imagine.
You're on your way to the moon with a decrepit billionaire,
and he has a cardiac arrest.
"Houston, we have a problem.
Our main revenue stream just lost his output.
Whoops."
Well, let's find out what we would do in this common,
everyday pickle.
How do you do CPR in space?
Now, perhaps it's
because people keep having medical emergencies
around me on airplanes,
but I spent some time a few years ago
reading the "International Space Station Medical Handbook".
Some light reading while you sit on your home replica
of the Zvezda Waste Collection System.
It has so much dentistry in it
that I fear it could actually cause cardiac arrest simply
by way of terminal boredom,
but nevertheless, it has some recommendations for CPR.
And I also consulted the recently published
space CPR guidelines
from the European Society of Aerospace Medicine.
The two key concepts for successful CPR, on Earth that is,
are chest compressions and defibrillation,
both as soon as possible.
The ISS has had a automated defibrillator
on board for many years now,
but delivering an electric shock
to a free-floating body surrounded
by life-supporting electrical equipment
might be somewhat challenging.
As for chest compressions, a few months ago,
I went up on a couple of parabolic,
that is weightless flights with the European Space Agency
or ESA, and I decided I was going to try to find out
how I would do CPR in weightlessness.
Something you should all know
if you truly are serious about learning basic life support.
To help me, I had a chat to Dr. Sindujen Sriharan,
who has published a study all about this.
- If a person is in cardiac arrest,
how are we able to do chest compressions
on them is the first difficulty.
That basic CPR compressions
that we can do on Earth is really because of gravity.
And so that's our first question is what's the best way
of doing CPR when you don't have any gravity?
- I thought I'd just add a serious tip actually
because this is an important topic
and you could genuinely save a life.
So I wanted to share the simple ABC
that we use for resuscitation,
which is easy to remember.
Airway, Breathing, Circulation,
Don't Ever Forget Gravity.
IIIII think that the reason ESA haven't returned my calls
about applying to become an astronaut is
because they've heard about my reputation on planes.
Fair enough, but I thought maybe I could respond
by sending them some footage of showing that I'm prepared
for any airborne emergency, including in weightlessness.
So what we're going to try
and do today is using this very high tech piece of kit
that I have definitely not stolen from my hotel,
we wanted to use a resuscitation doll,
but that was its over the weight limit.
So this is going to double
as a person who's had a cardiac arrest
in a weightless environment,
and how to do CPR in weightlessness.
So that's what we're going to try and figure out today.
Before we take a look at my attempt
at the different techniques,
I thought I'd address a few comments I got on my last video,
which if you haven't seen,
that was all about the science that takes place
on these weightlessness flights.
And the comments were about my mask.
So let me just say,
I'm aware of how often I had to readjust it.
The ones we got out there in France didn't seem
to pinch around my distinguished nose properly.
And as you know,
I have what could generously be described
as aggressive facial hair growth.
So from about three minutes after I finish shaving,
the friction coefficient between my face
and a surgical mask starts to increase exponentially,
and soon actually approaches infinity.
At work, I actually have to tape it onto my face
to stop it coming down.
And of course,
everyone on board had been tested multiple times
and was fully vaccinated,
plus I had a patient in cardiac arrest, people.
Come on, priorities.
(jaunty music)
So in this scenario,
our patient has just had a cardiac arrest.
They're not secured, neither am I.
So I'm just gonna try and do CPR
as I find them and see what happens.
So here, I'm gonna try and start chest compressions.
It's not very effective.
And in this scenario, guaranteed fatality.
- [Pilot] THIRTY.
(wistful strings)
(Cardiac grunting)
- [Neil] Graceful landing!
- So as you can see in that scenario,
my poor pillow suffered a guaranteed death
because I wasn't able to administer any CPR at all.
He started floating off, I started floating off.
Newton's third law, it was a disaster.
(jaunty music)
In this next technique,
it's called the Evetts-Russomano technique.
[Sindu] Thais Russomano is a very key person
in the field, in space CPR,
who was also on my study that I did, as my supervisor.
And so they created a method where they wrapped one leg
around the right shoulder
and then the other leg around the body
so that you could kind of trial CPR while you're floating.
- Huh.
I swear I've seen this one somewhere.
(I have no idea what this music is, honest)
You gotta imagine there's a head on this pillow,
and I have gotta straddle them
with my leg over their right shoulder
and my right leg around their waist
and try and give chest compressions that way.
So let's see what happens.
This technique, you clearly have to be fairly friendly
with your crewmates, but you know,
you're all living together, you're pretty close.
Okay, so I've straddled my counterpart,
and it's, oops, sorry, Sébastien.
So now I'm trying to give CPR like this.
Let me try and get out.
Can I get a blood gas please?
- [Pilot] THIRTY.
(Heroic anguish)
(jaunty music)
- Now with this technique,
both me and the patient are secured,
but obviously, that takes a little while to get going.
But you see, once you do it,
it's pretty effective.
The only problem is those first couple of minutes
while you get all the straps in place are all important
in terms of prognosis for a cardiac arrest.
[Sindu] Now there is another one called
the reverse bear hug method,
which is like a Heimlich maneuver,
which when someone's choking,
we kind of push on their chest.
So you kind of wrap your arms around someone
and you're pushing on their chest.
It's easy to do, but as you can imagine,
it can be quite tiring
'cause you're really just using the flexors of your arms
and so you could get tired really quickly.
(jaunty music)
One of the ones that NASA use is the handstand method
which is pretty much in the name.
And what they're trying to do is put their legs
on the ceiling and use their arms to push down on the body.
Now the hard thing about that is
that the actual height is very particular.
It needs to be particular,
and also the person needs to be restrained down.
What that means is you might be in an area
where the person can't be restrained.
The people who are not in cardiac arrest need to get them
to what we call the Crew Medical Restraint System.
- So this is the hypergravity before the next parabola.
For this technique,
we're going to try and secure my feet on the ceiling
and use the force to give chest impressions.
This is known as the handstand technique.
I might mess it up.
I definitely thought that this was the pick of the bunch
in terms of how good the chest compressions would be.
[Neil] Just take your time
- Keep going, that's it. - It's pretty good, actually.
You can use your arms.
Not bad, not bad.
Or you can lock them out and you can use your legs.
Yeah, these are good-quality chest compressions.
I think this would give an astronaut
who'd suffered a cardiac arrest the best chance of survival,
(Neil laughing in ESA)
right until I fell on top of and smothered them.
If you want my opinion, and I'd realise you might not,
but here it is anyway,
if you have a cardiac arrest in space, you're toast.
Success rates on Earth are already poor.
However, we do need to ask these questions
because up until now, astronauts have been very fit.
But space tourism will see older,
more infirm people go into space, and that's good.
It should be open to everybody, and we should be prepared.
Not to mention longer duration space flight,
where even if you are fit to start with,
you definitely won't be once you get to your destination
like Mars, and people's hearts might indeed misbehave.
Now, Sindu is a space medicine researcher,
and it's the only field of study I know
where papers contain sentences like this.
"11 anaesthetised Yorkshire swine were flown
in microgravity during parabolic flight."
I mean, they are literally making pigs fly.
Sindu's study looked at the quality of CPR
in simulated weightlessness,
lunar gravity, and Martian gravity.
- All these methods are really tiring.
CPR on Earth is really tiring.
In space, in microgravity, due to cardiac changes,
the muscular deconditioning,
it can be even harder to carry out CPR.
So firstly, from our results we found,
in 1g, which is terrestrial,
we were able to carry out effective CPR, as expected.
At Mars gravity and moon gravity,
we weren't able to reach what we want.
On Earth, it's 50 to 60 millimeters of CPR depth.
And what we found is, and most studies have found,
is CPR depth is the most difficult,
and that's because it requires the most force,
which we lose when we go onto the Moon or Mars
and into space.
People were able to do CPR for five minutes,
which is really hard actually, on Earth,
but they fatigued very quickly in simulated lunar gravities
within a minute up to two minutes.
The martian simulated gravity,
a bit longer, up to four minutes.
Now we don't know how that kind of plays out
in a real situation 'cause as we know,
on Earth, by two minutes, it is very tiring to do CPR.
- So to summarise, Sindu's research showed that on the Moon,
CPR is much less effective to the point
of basically being useless, and you get tired faster.
On Mars, CPR is much less effective and you get tired faster
and you'll be completely deconditioned
by the time you get there.
And in zero gravity,
CPR is extremely difficult
as I hope I've demonstrated to you.
And cardiac arrest is likely to be such a rare event
that no automated chest compression device will be taken
into space.
So if I have to give you one piece
of advice regarding this topic,
it would simply be don't have a cardiac arrest in space
because you're screwed.
(laughing in space tragedy)
- That is one way to look at it, yes.
- If you haven't already seen the first video I made
on this trip, you can watch the extended version on Nebula,
where I took a look at some of the medical
and scientific research that takes place
on board parabolic flights.
I scanned my heart and made myself sick
and I gave myself a mild concussion,
attempting to break dance in zero gravity.
It's a veritable fuselage of laughs.
You can also find a completely unedited version
of my chat with Space Doctor Sindu.
Signing up for Nebula
at the link below is the best way you can support me
to keep making videos on YouTube.
Oh, and let me finish by showing off my new microphone.
Doesn't it look nice?
It's actually a gift from Earthworks who make it.
It's not sponsored or anything,
they're just very nice and generous.
And if you look on the side there,
that is actually my real, that's the channel name,
but it's also my real-life ECG,
my heart tracing with all my real statistics, PR interval,
QRS and everything from an actual ECG that I had.
And I guess beauty influencers show off their looks.
As I'm not really blessed in that department,
I'm a cardiologist, so what's my flex?
Well, it's my heart rate.
And you can see my heart rate, which is 46,
and the ECG interpretation says marked sinus arrhythmia.
So this is also a heart rate variability flex.
It's not quite the same as rippling biceps or good looks,
but it's all I've got going for me,
so let me have this much.
- [Pilot] Twenty.
Thirty.
Pull out.
- [Rohin] Oh.
(blinks in disbelief that he got to do this)