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Nobody has experienced cardiac arrest in space, yet. But with plans to send humans back to the moon within a few years and on missions to Mars down the line, the chances are it will happen at some point.

A new study led by Jochen Hinkelbein at the University Hospital of Cologne in Germany provides the most comprehensive guidelines yet on how to perform cardiopulmonary resuscitation (CPR) in space.

鈥淭his is a critical work on a medical emergency that mercifully has not occurred yet during space flight,鈥� says Shawna Pandya, a physician and . Pandya says we can 鈥渞easonably expect [such an emergency] to occur during space flight given enough time, and need to prepare for [it]鈥�.

After reviewing the findings of 88 papers into performing CPR in microgravity, Hinkelbein and his colleagues recommend three methods for attempting the procedure in space.

In the first, called the Evetts-Russomano method, the rescuer wraps one leg over the patient鈥檚 shoulder and their other around the torso, interlocking their ankles. This holds the patient鈥檚 body in front of the rescuer, making it easier to perform chest compressions without having to strap them down.

鈥淭his can be started quickly and provides easy access to the patient鈥檚 airway,鈥� says Christina Mackaill at the Queen Elizabeth University Hospital in Glasgow, UK, and co-author of the paper. 鈥淗owever, it is possible that the rescuer and patient could drift and collide with the sides of the spacecraft and thus pose a potential risk.鈥�

The second method, the reverse bear hug, involves the rescuer wrapping their arms around the patient from behind, flexing and extending their arms into their chest.

In a third technique, the handstand, the patient is placed against a solid surface on the spacecraft while the rescuer places their feet on the opposite wall with their arms outstretched over their head. This can only be done if the dimensions of the spacecraft allow it, but it provides the most effective compressions.

So far, the studies into CPR in microgravity have all been conducted in simulated microgravity conditions 鈥� on parabolic flights that last around 20 seconds, using body suspension devices, or underwater. In order to truly test the guidelines, says Mackaill, studies need to be done in space.

鈥淲e should also be thinking about emerging and enabling technologies that can help facilitate these monumentally difficult tasks,鈥� says Pandya. An automatic chest compression device (ACCD), that can be strapped around the patient, could potentially provide regular compressions without tiring the rescuer. However, no ACCD has ever been tested during space flight.

鈥淭he Artemis missions [to return humans to the moon] will help us put our research into practice and test our guidelines during emergency simulations on a lunar mission or base,鈥� says Mackaill. 鈥淭his will help us understand and develop a standard operation procedure that we could apply for longer duration space missions, such as to Mars and beyond.鈥�