JMIR Publications

ABSTRACT

Background:

Future long duration space exploration missions such as travel to Mars will require higher levels of medical autonomy as communication time-delays or disruptions increase, and as an emergency return to Earth will no longer be a viable option for ensuring timely treatment. Although crew selection is proposed as the first line of defence to minimize medical risk for future missions, 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, a scoping review is currently conducted to better understand the depth and breadth of evidence about managing medical conditions in space.

Methods:

This scoping review was planned in adherence to standards of quality for scoping reviews employing the Levac, Colquhoun and O’Brien's six-stage methodology, with the results reported following the PRISMA extension for scoping reviews. In Stage 1, the research question was identified in collaboration with the Canadian Space Agency (CSA), the main knowledge user. Ten medical conditions were prioritized: acute coronary syndrome, atrial fibrillation, eye penetration, herniated disk, nephrolithiasis, pulmonary embolism, retinal detachment, sepsis, stroke and spaceflight associated neuro-ocular syndrome. In Stage 2, papers were identified with the help of an information specialist from Cochrane Canada Francophone. ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO and Web of science were searched. In Stage 3, studies will be selected and assessed using a three-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 to 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 a successful and medically safe mission as mankind plans to explore new frontiers in space exploration.