Ricardo Bertoglio Cardoso

A comparison between the 2010 and 2005 basic life support guidelines during simulated hypogravity and microgravity

BackgroundCurrent 2010 terrestrial (1Gz) CPR guidelines have been advocated by space agencies for hypogravity and microgravity environments, but may not be feasible. The aims of this study were to (1) evaluate rescuer performance over 1.5 min of external chest compressions (ECCs) during simulated Martian hypogravity (0.38Gz) and microgravity (μG) in relation to 1Gz and rest baseline and (2) compare the physiological costs of conducting ECCs in accordance with the 2010 and 2005 CPR guidelines.MethodsThirty healthy male volunteers, ranging from 17 to 30 years, performed four sets of 30 ECCs for 1.5 min using the 2010 and 2005 ECC guidelines during 1Gz, 0.38Gz and μG simulations (Evetts-Russomano (ER) method), achieved by the use of a body suspension device. ECC depth and rate, range of elbow flexion, post-ECC heart rate (HR), minute ventilation (VE), peak oxygen consumption (VO2peak) and rate of perceived exertion (RPE) were measured.ResultsAll volunteers completed the study. Mean ECC rate was achieved for all gravitational conditions, but true depth during simulated microgravity was not sufficient for the 2005 (28.5 ± 7.0 mm) and 2010 (32.9 ± 8.7 mm) guidelines, even with a mean range of elbow flexion of 15°. HR, VE and VO2peak increased to an average of 136 ± 22 bpm, 37.5 ± 10.3 L·min−1, 20.5 ± 7.6 mL·kg−1·min−1 for 0.38Gz and 161 ± 19 bpm, 58.1 ± 15.0 L·min−1, 24.1 ± 5.6 mL·kg−1·min−1 for μG from a baseline of 84 ± 15 bpm, 11.4 ± 5.9 L·min−1, 3.2 ± 1.1 mL·kg−1·min-1, respectively. RPE was the only variable to increase with the 2010 guidelines.ConclusionNo additional physiological cost using the 2010 basic life support (BLS) guidelines was needed for healthy males performing ECCs for 1.5 min, independent of gravitational environment. This cost, however, increased for each condition tested when the two guidelines were compared. Effective ECCs were not achievable for both guidelines in simulated μG using the ER BLS method. This suggests that future implementation of an ER BLS in a simulated μG instruction programme as well as upper arm strength training is required to perform effective BLS in space.

Three methods of manual external chest compressions during microgravity simulation.

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.

Towards designing for equity: active citizen participation in eHealth

Purpose – Reducing inequity in accessing healthcare among rural and remote populations remains a problem. Internationally, eHealth is now touted as a potential solution, with a range of diverse approaches and impacts. Yet, the equity gains of implementing eHealth are often not realized due to a lack of effective strategies for citizen participation. The purpose of this paper is to present the background to, and results of, a multidisciplinary eHealth assistance project in a remote region of the Brazilian Amazon, highlighting the importance of citizen participation within planning processes.Design/methodology/approach – The project was conducted in three phases – pre‐mission, mission, and post‐mission. Discussions were held between health teams and local community leaders, and were coordinated by government health organizations in partnership with the Amazon State University. A multidisciplinary team visited five remote communities in the Brazilian Amazon, where participants underwent clinical assessment u...

Evaluation of the photo-electrocardiogram as a tool for formative second opinion

AIMS: This study aimed to evaluate the photo-electrocardiogram (photo-ECG), as an alternative tool to enable remote formative second opinion in cardiology. METHODS: Fifty paper electrocardiograms (ECGs) were photographed two times, the first using a Canon digital camera, 0.3 megapixel resolution, and the second using a Nokia mobile phone integrated camera, 2.0 megapixel resolution, resulting in 100 Photo-ECGs. A pilot study was responsible for determining the acquisition method. The 100 Photo-ECGs were randomized, encrypted and sent by e-mail to a remote cardiologist, while the 50 paper ECGs were delivered to him in person, without randomization. Gender and age were the only patient information made available to the specialist. RESULTS: Data analysis demonstrated a disagreement in 14 of 50 interpretations (28%) when comparing paper ECGs to the Canon camera photo-ECGs and in 13 of 50 interpretations (26%) when comparing paper ECGs to the Nokia camera photo-ECGs. The Kappa test revealed a fair agreement (Kappa=0.356) between interpretations when comparing the original ECGs to their respective photo-ECGs for both camera devices. CONCLUSIONS: The concordance between photo-ECGs and original tracings demonstrated that the method described herein has the potential for use as a tool to assist clinical practice, provided that the acquisition of photo-ECGs is adapted so as to improve exam images. Only with good to very good concordance between the original ECGs and photo-ECGs will remote formative second opinion be possible, giving better diagnostic and therapeutic options.

eHealth Projects of the Microgravity Centre

This Chapter aims to present the activities of the Telemedicine Laboratory of the Microgravity Centre/PUCRS (Brazil) and to discuss eHealth initiatives around the globe, emphasising the benefits of the use of telecommunication and computer technologies in remote and deprived areas, where specialised medical care is limited or non-existent. Based on the experience of this Lab in the areas of eResearch, eLearning and eHealth Assistance, a review of virtual tools used in academic activities and of telemedicine endeavours applied for the identification and treatment of a broad range of diseases worldwide is presented. Relevant eHealth terminology is also introduced to help the reader gain a better understanding of the concepts described in this text.

The science transfer series: telemedicine in education, research and assistance

T is considered to be the delivery of healthcare services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of diseases and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interest of advancing the health of individuals and their communities. The term ‘telemedicine’ first came into use in the 1970s, but it is not a new concept and initiatives that fit the aforementioned definition have been applied since the early 1900s. To a large extent, the development of telemedicine has followed the advent of new technologies. The beginning of the 20th century welcomed the widespread use of telephones, an invention that has been used for medical work since its creation. Physicians communicated medical information to ships at sea using radios in the 1920s. Commercial air travel also adopted radio-based telemedicine for passengers taken ill mid-flight. Telemedicine experienced a boom with the Space Race and development of satellite technologies, enabling healthcare to be delivered in remote locations without the presence of a doctor. In recent times there has been an exponential proliferation of telemedicine initiatives around the world, both in number and diversity. This is in large part due to the internet and mobile phones. Internationally, the World Health Organization’s health-for-all policy for the 21st century centers on telemedicine and health telematics. Due to these technological advances, health professionals in remote areas are able to access information relevant to patient disease, diagnosis and therapy via the Internet, enabling the improvement of health services in areas lacking in specialist opinion. PUCRS University, through the Telemedicine Laboratory of the Microgravity Center, at the School of Engineering, has been developing projects in this area, with the intention of filling the gaps in current provision of health services in Brazil, which lack efficient tools to solve problems and difficulties in the diffusion of specialist services. This Laboratory, coordinated by Prof. Helena Willhelm de Oliveira of the PUCRS School of Dentistry, aims to expand the frontiers of health services through the development of research projects, using new communication technologies. To accomplish this goal, the Telemedicine Laboratory develops inter-institutional and multidisciplinary projects which are divided into three subareas: education, research and assistance.