Long duration spaceflights to the Moon or Mars are at risk for emergency medical events. Managing a hypoxemic distress and performing an advanced airway procedure such as oro-tracheal intubation may be complicated under weightlessness due to ergonomic constraints. An emergency free-floating intubation would be dangerous because of high failure rates due to stabilization issues that prohibits its implementation in a space environment. Nevertheless, we hypothesized that two configurations could lead to a high first-pass success score for intubation performed by a free-floating operator. In a non-randomized, controlled, cross-over simulation study during a parabolic flight campaign, we evaluated and compared the intubation performance of free-floating trained operators, using either a conventional direct laryngoscope in an ice-pick position or an indirect laryngoscopy with a video-laryngoscope in a classic position at the head of a high-fidelity simulation manikin, in weightlessness and in normogravity. Neither of the two tested conditions reached the minimal terrestrial ILCOR recommendations (95% first-pass success) and therefore could not be recommended for general implementation under weightlessness conditions. Free-floating video laryngoscopy at the head of the manikin had a significant better success score than conventional direct laryngoscopy in an ice-pick position. Our results, combined with the preexisting literature, emphasis the difficulties of performing oro-tracheal intubation, even for experts using modern airway devices, under postural instability in weightlessness. ClinicalTrials registration number NCT05303948.

前往月球或火星的长时间太空飞行存在发生紧急医疗事件的风险。由于人体工程学的限制，在失重状态下处理低氧血症和执行高级气道手术（例如经口气管插管）可能会很复杂。紧急自由浮动插管会很危险，因为稳定性问题阻碍了其在太空环境中的实施，导致失败率很高。尽管如此，我们假设两种配置可能会导致自由浮动操作员进行插管时获得较高的首次成功率。在抛物线飞行活动期间的非随机、受控、交叉模拟研究中，我们评估并比较了自由漂浮训练有素的操作员的插管性能，使用传统的冰锥位置直接喉镜或间接喉镜视频喉镜位于高保真模拟人体头部的经典位置，处于失重和常重力状态。两种测试条件均未达到地面 ILCOR 建议的最低要求（首次通过成功率为 95%），因此不能建议在失重条件下普遍实施。与传统的冰锥位置直接喉镜检查相比，在人体模型头部进行自由浮动视频喉镜检查的成功率明显更高。我们的研究结果与现有文献相结合，强调了在失重姿势不稳定的情况下进行经口气管插管的困难，即使对于使用现代气道装置的专家来说也是如此。临床试验注册号 NCT05303948。