INTEGRATION OF AN AUTOMATED EXTERNAL DEFIBRILLATOR (AED) ABOARD THE INTERNATIONAL SPACE STATION (ISS) - A CLINICAL PERSPECTIVE

Introduction: Astronaut crew medical officers (CMO) on the International Space Station (ISS) are usually not physicians and therefore, it is essential to have medical protocols that can be reliably executed autonomously. Automated External Defibrillators (AED) are designed for minimally trained first responders to treat sudden cardiac arrest. Accordingly, NASA's Medical Operations Branch (MOB) wants to replace the current ISS defibrillator with an AED. Successful AED use in space requires the ISS Advanced Cardiac Life Support (ACLS) protocol be reviewed so AED integration maintains proper levels of care. The purpose of this project was to review current ISS clinical protocols of the ISS Health Maintenance System (HMS) and determine how to best integrate an AED into ACLS procedures while either complimenting or improving the standard of care. Methods: A team consisting of operational flight surgeons, the ISS Medical Checklist Book Manager, and the Medical Simulation Laboratory Working Group (Wyle) reviewed the current ACLS protocols requiring the ISS defibrillator. The task was to identify specific steps where using the new ISS AED would be incompatible with current ISS ACLS procedures. Identification of these incompatible ACLS steps required the team to generate AED-compatible solutions and obtain concurrence from the MOB and International Partners. Results: The team identified several areas in the current ISS defibrillator ACLS algorithm where use of an AED could not be integrated into the current ISS ACLS algorithm. The team derived solutions for these areas of the algorithm or the appropriate ISS HMS protocol. The team also derived and documented a test and validation process to be used for the certification and acceptance testing of HMS protocols during integration of new medical hardware. Discussion: The team was successful in identifying problem areas in ISS ACLS protocols using an AED and made changes to ISS procedures and protocols to ensure the best ACLS clinical outcome.