• Tobias Warnecke, Lisa Dauth, Anton Ahlbäck, James DuCanto, Elisabeth Fleischhammer, Carlos Glatz, Steffen Kerkhoff, Alexander Mathes, Jan Schmitz, Clement Starck, Seamus Thierry, and Jochen Hinkelbein.
• Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
• Acta Anaesthesiol Scand. 2021 May 1; 65 (5): 681-687.

BackgroundMedical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity.MethodsIn this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant free-floating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt.ResultsA total of 20 participants performed placement of each device in both gravity conditions in an Airway mannequin. The fastest time to initial ventilation in simulated microgravity was possible with the laryngeal tube (18.9 ± 8 seconds) followed by laryngeal mask (20.1 ± 9 seconds). The I-gel® supraglottic airway device required substantially more time for successful insertion in simulated microgravity (35.4 ± 25 seconds) as did endotracheal tube intubation by direct laryngoscopy (70.4 ± 35 seconds). Simulated microgravity conditions prolonged time to initial ventilation by 3.3 seconds (LM), 3.9 seconds (LT), 19.9 seconds (I-gel) and 43.1 seconds (endotracheal intubation, ETI) when compared to poolside attempts in normogravity.ConclusionIn simulated microgravity conditions, use of the laryngeal tube or laryngeal mask provided the quickest time to initial ventilation, without deliberate tethering of the mannequin and rescuer to a fixed surface. Endotracheal intubation required significantly longer procedure times and, thus, was considered insufficient for clinical use in microgravity.© 2021 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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