Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Scoping Review Protocol
Kim-Anh Tran MSc; Neal William Pollock PhD; Caroline Rhéaume MD, PhD; Payal Sonya Razdan MPH; […] Patrick Michel Archambault MSc, MD
https://www.researchprotocols.org/2021/3/e24323/PDF
Abstract
Background
Future long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and autonomy of crew members. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Québec, QC) and Université Laval (Québec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes.
Objective
To complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space.
Methods
This scoping review adheres to quality standards for scoping reviews, employing Levac, Colquhoun, and O’Brien’s 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews) extension for scoping reviews. In Stage 1, the research question was identified in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In Stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In Stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In Stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google Spreadsheets for shared access. In Stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in Stage 6, the findings will be shared with the CSA to guide the completion of this project.
Results
This study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. Stages 2-6 are planned to be completed by the beginning of 2021.
Conclusions
This scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps important to address for future research to ensure successful and medically safe missions as humankind embarks upon new frontiers of space exploration.
Keywords
spaceflight; astronauts; microgravity; weightlessness; acute coronary syndrome; arrhythmia; atrial fibrillation; eye penetration; intraocular foreign body; herniated disk; nephrolithiasis; pulmonary embolism; retinal detachment; sepsis; stroke; spaceflight associated neuro-ocular syndrome