BLUNT TRAUMA AND OPERATIVE CARE IN MICROGRAVITY - A REVIEW OF MICROGRAVITY PHYSIOLOGY AND SURGICAL INVESTIGATIONS WITH IMPLICATIONS FOR CRITICAL CARE AND OPERATIVE TREATMENT IN-SPACE

BACKGROUND: The assembly of the International Space Station in a low e arth orbit will soon become a reality. The National Aeronautics and Sp ace Administration envisions inhabited lunar bases and staffed mission s to Mars in the future. Increasing numbers of astronauts, constructio n of high-mass structures, increased extra-vehicular activity, and pro longed if not prohibitive medical evacuation times to earth underscore the need to address requirements for trauma care in nonterrestrial en vironments. STUDY DESIGN: A search was carried out to review the relev ant literature in the MEDLINE and SPACELINE databases. All related Tec hnical, Corporate, and Flight Test Reports in the KRUG Life Sciences c orporate library were also reviewed. Bibliographies of all articles we re then reviewed from these papers to identify additional pertinent li terature. Senior Russian investigators reviewed the Russian literature and translated Russian publications when appropriate. Personal commun ication and discussion with active microgavity investigators and ongoi ng microgravity research supplemented published reports. RESULTS: A la rge volume of data exist to document the multiple detrimental physiolo gic effects of microgravity exposure on human physiology. Organs syste ms such as cardiovascular, neurohumoral, immune, hematopoetic, and mus culoskeletal systems map be particularly affected. These physiologic c hanges suggest an impaired ability to withstand major systemic trauma. Observational data also suggest adverse changes in numerous aspects o f response to wounding and injury, and in areas such as the behavior o f hemorrhage, microbiologic flora, and wound healing. In addition to a n increased volume of ongoing and anticipated basic science research i n microgravity physiology, preliminary studies of clinical diagnosis a nd therapy have been carried out in microgravity and microgravity labo ratories. The feasibility of a wide range of ancillary critical care t echniques has been verified in the parabolic flight model of micrograv ity. Although Russian investigators first performed laparotomies on ra bbits in parabolic flight in 1967, only recently have American investi gators demonstrated the reproducible feasibility of open and endoscopi c surgical procedures under general anesthetic in animal models in a m icrogravity environment. CONCLUSIONS: With appropriate instrumentation and personnel, the majority of resuscitative and surgical interventio ns required to stabilize a severely injured astronaut are feasible in a microgravity environment. Onboard limitations in mass, volume, and p ower that are ever present in any spacecraft design will limit the rea listic capabilities of the medical system. Standard proved and tested trauma and operative management protocols will constitute the basis fo r extra-terrestrial care. Surgeons should familiarize themselves with the microgravity environment and remain active in planning trauma care for the continued exploration of space.