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Experiment/Payload Overview

Brief Summary

Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and Braslet-M Occlusion Cuffs (Braslet) is Station Development Test Objective (SDTO) 17011 sponsored by National Aeronautics and Space Administration (NASA) and Russian Federal Space Agency (FSA). Braslet is testing the performance of occlusion cuffs in modifying fluid shifts that occur early during physiological transition into the space environment. Understanding the effects of this countermeasure on cardiovascular function will be useful for both medical operations and future research.

Principal Investigator

J. Michael Duncan, M.D., Johnson Space Center, Houston, TX, United States

Valery Bogomolov, Ph.D., M.D., Institute for Biomedical Problems, Moscow, , Russia

Co-Investigator(s)/Collaborator(s)

Ashot Sargsyan, M.D., Wyle, Houston, TX, United States

Douglas Ebert, Ph.D., Wyle, Houston, TX, United States

Douglas R. Hamilton, Ph.D., M.D., Wyle, Houston, TX, United States

Irina Alferova, Ph.D., M.D., Institute for Biomedical Problems, Moscow, , Russia

Scott Dulchavsky, Ph.D., M.D., Henry Ford Hospital System, Detroit, MI, United States

Vladimir Matveev, M.D., Gagarin Cosmonaut Training Center, Star City, , Russia

Payload Developer

Johnson Space Center, Houston, TX, United States
Wyle, Integrated Science and Engineering, Houston, TX, United States
Gagarin Cosmonaut Training Center, Star City, , Russia
Institute for Biomedical Problems, Moscow, , Russia

Sponsoring Space Agency

National Aeronautics and Space Administration (NASA)

Sponsoring Organization:

Exploration Systems Mission Directorate (ESMD)

ISS Expedition Duration:

October 2007 - April 2009

Expeditions Assigned

16, 18

Previous ISS Missions

Information Pending

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Experiment/Payload Description

Research Summary

• The Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and Braslet-M Occlusion Cuffs, SDTO 17011 (Braslet) will result in ultrasound methodology for the measurement of cardiovascular volume and function in microgravity.



• Ultrasound is an advanced diagnostic tool typically operated by experienced technicians with results interpreted by specialized physicians. Recent advances in remote guidance techniques on the International Space Station (ISS) will allow diagnostic quality ultrasound exams using crewmember operators who have little or no ultrasound experience. Ongoing efforts are required to validate procedures that will allow complex, focused ultrasound exams on the ISS.



• Braslet will also utilize the Russian Braslet-M device, a current Russian operational countermeasure which compresses the upper thigh to slow the venous return of blood from the legs to the heart. The overall cardiovascular effects of the Braslet-M device are not completely understood. This SDTO combines the use of Braslet-M devices as a means to acutely alter volume distribution while focused ultrasound measurement techniques are developed.



• The successful development of this measurement technique will provide a means of measuring cardiovascular function which will be useful for both medical operations and future research. Methodologies and data will be created through this SDTO that will result in significant new capability and knowledge which will enhance areas of operational space medicine such as clinical management of volume shifts induced by altered gravity, clinical diagnostic ultrasound in space flight, and telemedicine.

Description

The Validation of On-Orbit Methodology for the Assessment of Cardiac Function and Changes in the Circulating Volume Using Ultrasound and Braslet-M Occlusion Cuffs, SDTO 17011 (Braslet) is a collaborative effort between the National Aeronautics and Space Administration (NASA) and Russian Federal Space Agency (FSA) for which each organization acts as a portion of the co-investigator team. The goal of this investigation is to establish a valid ultrasound methodology for assessing a number of aspects of central and peripheral hemodynamics and cardiovascular function, specifically in rapid changes in intravascular circulating volume. This SDTO will use Braslet-M occlusion cuffs, which are a Russian-made operational countermeasure already pre-calibrated and available onboard for each ISS crewmember.

Braslet will use multiple modes of ultrasound imaging and measurements, in combination with short-term application of Braslet-M occlusive cuffs and cardiopulmonary maneuvers (Valsalva, Mueller) to demonstrate and to evaluate the degree of changes in the circulating volume on orbit. This will be accomplished by performing echocardiographic examinations in multiple modes (including Tissue Doppler mode), ultrasound measurements of lower extremity venous and arterial vascular responses to Braslet-M device under nominal conditions and also during cardiopulmonary Mueller and Valsalva maneuvers. Identical measurements will be repeated without Braslet-M, with Braslet-M applied, and immediately after releasing the occlusion device.

In addition to the primary goal of methodology validation for cardiovascular evaluations (including those related to circulating volume changes and manipulations), operationally relevant procedures will be developed to rule out a number of mission-impacting medical conditions. Space-adapted and non-invasive methodologies to study peripheral and central hemodynamics are a valid contribution of this investigation that can later be used to evaluate other countermeasures, as well as to diagnose or rule out arterial, venous, and cardiac pathology. The effect of prolonged weightlessness on venous capacitance or venous blood flow has not been effectively studied using ultrasound, and the protocols developed by this investigation could be used by other investigators for such purposes.

The data gathering techniques for the volume status evaluation will be validated through assessment of Braslet-M application/release effects, and the use of ultrasound will provide hitherto unobtainable data on the overall effects of Braslet-M as a countermeasure. This investigation will provide pilot data regarding the effect of occlusion cuffs on the cardiovascular system of long-duration crewmembers and reveal whether it can be used as a means of acute or chronic volume manipulation for medical purposes. This activity will also determine the on-orbit and ground resources needed to enable such research during future ISS increments until a full-scale evaluation of the Braslet-M device can be performed. This future work would specifically examine the Braslet-M effects on cardiovascular system physiology, its safety, utility, and potentially new or expanded uses. The results of the current, limited investigation will be used to optimize the pre-flight and in-flight training modules for subsequent expedition crews. The lessons learned from this investigation will be used to propose a more formal operationally relevant investigative protocol for future increments, which in turn will address the question regarding utility of Braslet-M for ISS and exploration-class missions.

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Applications

Space Applications

This SDTO will provide refinements in remote guidance techniques which will allow detailed ultrasound exams to be performed in space with remote guidance by technicians and physicians on the ground. This will enhance the diagnostic and research capabilities of the ISS ultrasound. Data will also be collected regarding the utility and potentially expanded uses of the Braslet-M device for both ISS and exploration class missions. A more detailed understanding of the cardiovascular response to microgravity-induced fluid shifts will also be gained from this work.

Earth Applications

Refinements in remote guidance techniques provided by Braslet will similarly allow detailed ultrasound exams to be performed in terrestrial locations remote from experienced ultrasound technicians and physicians. Examples include rural clinics, disaster areas, and military applications. Additionally, during this SDTO data will be collected regarding the physiological responses to altered circulatory volume distribution which may lend insight to the diagnosis and treatment of terrestrial conditions (such as cardiovascular disease) which result in altered fluid status.

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Operations

Operational Requirements

A total of five subjects with two scans each have been requested for this SDTO. Subjects are eligible if they are long term residents of ISS, but must be on board at least two weeks to ensure that they have become fully adapted to microgravity from a fluid distribution standpoint. Subjects must also have not exercised, eaten large meals, or worn the Braslet device in the period immediately preceding the scanning session. Ideally, one scanning session per subject is near the beginning of the mission, while the second is near the end of their stay on ISS. Each scanning session is expected to last 1 hour, not including ultrasound deployment and stowage, which is expected to take an additional 1 hour and 20 minutes (per deployment). Data will be recorded in mission control in real time, and additional high resolution images will be downliked following the scanning sessions. The ultrasound and the Braslet devices are available onboard, so no upmass is required, and no hardware or sample return is required.

Operational Protocols

The ISS ultrasound will be deployed and activated. One ISS crewmember per mission will serve as the ultrasound operator and will be remotely guided to scan a subject (self scanning is also included). Detailed ultrasound scans will be taken of the heart, jugular vein (neck), and femoral vein (leg). Parameters include baseline (control), with Braslet-M applied, and with respiratory maneuvers (Valsalva, Mueller). The real time ultrasound video image and cabin video will be privatized and displayed to the experiment team in mission control. Data will be recorded and stored on the ground during the scanning session, and selected higher resolution images will be downlinked from the ISS ultrasound following the experiment. Complete analysis of the ultrasound measurements will be performed following the scanning session.

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Results/More Information

Information Pending

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Related Web Sites

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Publications

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Ground Based Results Publications

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ISS Patent Publications

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Related Publications

• Sargsyan A E,Hamilton D R,Melton S L,Young J ,The International Space Station Ultrasound Imaging Capability Overview for Prospective Users NASA/TP 2006
• Grigoriev A I,Bugrov S A,Bogomolov V V,Egorov A D,Polyakov V V,Tarasov I K,Shulzhenko E B,Main medical results of extended flights on space station Mir in 1986-1990 Acta Astronautica 1993 581-585
• Fincke E M,Padalka G ,Lee D ,van Holsbeeck M ,Sargsyan A E,Hamilton D R,Martin D ,Melton S L,McFarlin K ,Dulchavsky S A,Evaluation of Shoulder Integrity in Space: First Report of Musculoskeletal US on the International Space Station Radiology 2005 234 319-322
• Hamilton D R,Murray J D,Kapoor D ,Kirkpatrick A W,Cardiac health for astronauts: current selection standards and their limitations Aviation, Space and Environmental Medicine 2005 76 615-626
• Hamilton D R,Sas R ,Tyberg J V,Atrioventricular nonuniformity of pericardial constraint American Journal of Physiology Heart and Circulatory Physiology 2004 287 H1700-H1704
• Alferova I V,Turchaninova V F,Golubchikova Z A,Liamin V R,Analysis and evaluation of the functional state of cardiovascular system in cosmonauts during long-term space flights Fiziologiia cheloveka 2003 29 5-11
• Charles J B,Lathers C M,Cardiovascular Adaptation to Spaceflight Journal of Clinical Pharmacology 1991 31 1010-1023
• Chiao L ,Sharipov S ,Sargsyan A E,Melton S ,Hamilton D R,McFarlin K ,Dulchavsky S A,Ocular examination for trauma; clinical ultrasound aboard the International Space Station Journal of Trauma 2005 58 885-889
• Foale C M,Kaleri A Y,Sargsyan A E,Hamilton D R,Melton S ,Margin D ,Dulchavsky S A,Diagnostic instrumentation aboard ISS: just in time training for non-physician crewmembers Aviation, Space and Environmental Medicine 2005 76 594-598
• Sargsyan A E,Hamilton D R,Jones J A,Melton S ,Whitson P A,Kirkpatrick A W,Martin D ,Dulchavsky S A,FAST at MACH 20: Clinical Ultrasound Aboard the International Space Station The Journal of Trauma, Injury, Infection, and Critical Care 2004 58 35-39
• Buckey J C,Gaffney A F,Lane L D,Central Venous Pressure in Space New England Journal of Medicine 1993 328 1853-1854
• Tyberg J V,Hamilton D R,Orthostatic hypotension and the role of changes in venous capacitance Medicine and Science in Sports and Exercise 1996 28 S29-31
• Convertino V A,Clinical Aspects of the Control of Plasma Volume at Microgravity and During Return to One gravity Medicine and Science in Sports and Exercise 1996 28 S45-S52
• Hamilton D R,Dani R S,Semlacher R A,Right atrial and right ventricular transmural pressures in dogs and humans Effects of the pericardium Circulation 1994 90 2492-2500
• Moore P T,Thornton W E,Space Shuttle Inflight and Postflight Fluid Shifts Measured by Leg Volume Changes Aviation, Space and Environmental Medicine 1987 58 A91-A96
• White R J,Blomqvist C G,Central Venous Pressure and Cardiac Function During Spaceflight Journal of Applied Physiology 1998 85 738-746

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Images

NASA Image: ISS010E18770 - ISS Commander and Science Officer Leroy Chiao performs an ultrasound scan on the eye of Flight Engineer Salizhan Sharipov during ISS Expedition 10.

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Braslet-M Occlusion Cuffs. Image courtesy of the Russian Federal Space Agency (FSA).

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