Jump to content

Assessment of PFO as Related to DCS in the Spaceflight Environment and During Ground Testing


Recommended Posts

  • Publishers
Posted

6 min read

Preparations for Next Moonwalk Simulations Underway (and Underwater)

PFO, OCHMO
In-person participants L-R standing: Dave Francisco, Joanne Kaouk, Dr. Richard Moon, Dr. Tony Alleman, Dr. Sean Hardy, Sarah Childress, Kristin Coffey, Dr. Ed Powers, Dr. Doug Ebersole, Dr. Steven Laurie, Dr. Doug Ebert; L-R seated: Dr. Alejandro Garbino, Dr. Robert Sanders, Dr. Kristi Ray, Dr. Mike Gernhardt, Dr. Joseph Dervay, Dr. Matt Makowski). Not pictured: Dr. Caroline Fife

In June 2024, the NASA Office of the Chief Health and Medical Officer (OCHMO) Standards Team hosted an independent assessment working group to review the status and progress of research and clinical activities intended to mitigate the risk of decompression sickness (DCS) related to patent foramen ovale (PFO) during spaceflight and associated ground testing and human subject studies.

Decompression sickness (DCS) is a condition which results from dissolved gases (primarily nitrogen) forming bubbles in the bloodstream and tissues. It is usually experienced in conditions where there are rapid decreases in ambient pressure, such as in scuba divers, high-altitude aviation, or other pressurized environments. The evolved gas bubbles have various physiological effects and can obstruct the blood vessels, trigger inflammation, and damage tissue, resulting in symptoms of DCS. NASA presently classifies DCS into two categories: Type I DCS, which is less severe, typically leads to musculoskeletal symptoms including pain in the joints or muscles, or skin rash. Type II DCS is more severe and commonly results in neurological, inner ear, and cardiopulmonary symptoms. The risk of DCS in spaceflight presents during extravehicular activities (EVAs) in which astronauts perform mission tasks outside the spaceflight vehicle while wearing a pressurized suit at a lower pressure than the cabin pressure. DCS mitigation protocols based on strategies to reduce systemic nitrogen load are implemented through the combination of habitat environmental parameters, EVA suit pressure, and breathing gas procedures (prebreathe protocols) to achieve safe and effective mission operations. The pathophysiology of DCS has still not been fully elucidated since cases occur despite the absence of detected gas bubbles but includes right to left shunting of venous gas emboli (VGE) via several potential mechanisms, one of which is a Patent Foramen Ovale (PFO).

decompression-sickness-dcs-arterial-gas-

From: Dr. Schochet & Dr. Lie, Pediatric Pulmonologists

Reference OCHMO-TB-037 Decompression Sickness (DCS) Risk Mitigation technical brief for additional information.

A PFO is a shunt between the right atrium and the left atrium of the heart, which is a persisting remnant of a physiological communication present in the fetal heart. Post-natal increases in left atrial pressure usually force the inter-septal valve against the septum secundum and within the first 2 years of life, the septae permanently fuse due to the development of fibrous adhesions. Thus, all humans are born with a PFO and approximately 75% of PFOs fuse following childbirth. For the 25% of the population’s whose PFOs do not fuse, ~6% have what is considered by some to be a large PFO (> 2 mm). PFO diameter can increase with age. The concern with PFOs is that with a right to left shunt between the atria, venous emboli gas may pass from the right atrium (venous) to the left atrium (arterial) (“shunt”), thus by-passing the normal lung filtration of venous emboli which prevent passage to the arterial system. Without filtration, bubbles in the arterial system may lead to a neurological event such as a stroke. Any activity that increases the right atrium/venous pressure over the left atrium/arterial pressure (such as a Valsalva maneuver, abdominal compression) may further enable blood and/or emboli across a PFO/shunt.

patent-foramen-ovale-pfo.png?w=571

From: Nuffield Department of Clinical Neurosciences

The purpose of this working group was to review and provide analysis on the status and progress of research and clinical activities intended to mitigate the risk of PFO and DCS issues during spaceflight. Identified cases of DCS during NASA exploration atmosphere ground testing conducted in pressurized chambers led to the prioritization of the given topic for external review. The main goals of the working group included:

  1. Quantification of any increased risk associated with the presence of a PFO during decompression protocols utilized in ground testing and spaceflight EVAs, as well as unplanned decompressions (e.g., cabin depressurization, EVA suit leak).
  2. Describe risks and benefits of PFO screening in astronaut candidates, current crewmembers, and chamber test subjects.
  3. What are potential risk reduction measures that could be considered if a person was believed to be at increased risk of DCS due to a PFO?
  4. What research and/or technology development is recommended that could help inform and/or mitigate PFO-related DCS risk?

The working group took place over two days at NASA’s Johnson Space Center and included NASA subject matter experts and stakeholders, as well as invited external reviewers from areas including cardiology, hypobaric medicine, spaceflight medicine, and military occupational health. During the working group, participants were asked to review past reports and evidence related to PFOs and risk of DCS, materials and information regarding NASA’s current experience and practices, and case studies and subsequent decision-making processes. The working group culminated in an open-forum discussion where recommendations for current and future practices were conferred and subsequently summarized in a final summary report, available on the public NASA OCHMO Standards Team website.

The following key findings are the main take-aways from the OCHMO independent assessment:

  1. In an extreme exposure/high-risk scenario, excluding individuals with a PFO and treating PFOs does not necessarily decrease the risk of DCS or create a ‘safe’ environment. It may create incremental differences and slightly reduce overall risk but does not make the risk zero. There are other physiological factors that also contribute to the risk of DCS that may have a larger impact (see 7.0 Other Physiological Factors in the findings section). 
  2. Based on the available evidence and the risk of current decompression exposures (based on current NASA protocols and NASA-STD-3001 requirements to limit the risk of DCS), it is not recommended to screen for PFOs in any spaceflight or ground testing participants. The best strategy to reduce the risk of DCS is to create as safe an environment as possible in every scenario, through effective prebreathe protocols, safety, and the capability to rapidly treat DCS should symptoms occur. 
  3. Based on opinion, no specific research is required at this time to further characterize PFOs with DCS and altitude exposure, due to the low risk and preference to institute adequate safe protocols and ensuring treatment availability both on the ground and in spaceflight.
  4. For engineering protocols conducted on the ground, it should be ensured that the same level of treatment capability (treatment chamber in the immediate vicinity of the testing) is provided as during research protocols. The ability to immediately treat a DCS case is critical in ensuring the safety of the test subjects.

The full summary report includes detailed background information, discussion points from the working group, and conclusions and recommendations. The findings from the working group and resulting summary report will help to inform key stakeholders in decision-making processes for future ground testing and spaceflight operations with the main goal of protecting crew health and safety to ensure overall mission success.

About the Author

Sarah D. Childress

Sarah D. Childress

Keep Exploring

Discover More Topics From NASA

View the full article

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Similar Topics

    • By NASA
      3 Min Read NASA’s IMAP Arrives at NASA Marshall For Testing in XRCF  
      On March 18, NASA’s IMAP (Interstellar Mapping and Acceleration Probe) arrived at NASA’s Marshall Space Flight Center in Huntsville, Alabama, for thermal vacuum testing at the X-ray and Cryogenic Facility, which simulates the harsh conditions of space.
      The IMAP mission is a modern-day celestial cartographer that will map the solar system by studying the heliosphere, a giant bubble created by the Sun’s solar wind that surrounds our solar system and protects it from harmful interstellar radiation. 
      To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
      NASA’s IMAP mission being loaded into the thermal vacuum chamber of NASA Marshall Space Flight Center’s X-Ray and Cryogenic Facility (XRCF) in Huntsville, Alabama. IMAP arrived at Marshall March 18 and was loaded into the chamber March 19.Credit: NASA/Johns Hopkins APL/Princeton/Ed Whitman Testing performed in the X-ray and Cryogenic Facility will help to assess the spacecraft before its journey toward the Sun. The IMAP mission will orbit the Sun at a location called Lagrange Point 1 (L1), which is about one million miles from Earth towards the Sun. From this location, IMAP can measure the local solar wind and scan the distant heliosphere without background from planets and their magnetic fields. The mission will use its suite of ten instruments to map the boundary of the heliosphere, analyze the composition of interstellar particles that make it through, and investigate how particles change as they move through the solar system. 
      Furthermore, IMAP will maintain a continuous broadcast of near real-time space weather data from five instruments aboard IMAP that will be used to test new space weather prediction models and improve our understanding of effects impacting our human exploration of space. 
      Team members from Marshall Space Flight Center in Huntsville, Alabama, install IMAP into the XRCF’s chamber dome before the start of the thermal vacuum test. NASA/Johns Hopkins APL/Princeton/Ed Whitman While inside the Marshall facility, the spacecraft will undergo dramatic temperature changes to simulate the environment during launch, on the journey toward the Sun, and at its final orbiting point. The testing facility has multiple capabilities including a large thermal vacuum chamber which simulates the harsh conditions of space such as extreme temperatures and the near-total absence of an atmosphere. Simulating these conditions before launch allow scientists and engineers to identify successes and potential failures in the design of the spacecraft. 
      Team members from Marshall Space Flight Center in Huntsville, Alabama work to close the chamber door of the XRCF for IMAP testing. The chamber is 20 feet in diameter and 60 feet long making it one of the largest across NASA. NASA/Johns Hopkins APL/Princeton/Ed Whitman “The X-ray and Cryogenic Facility was an ideal testing location for IMAP given the chamber’s size, availability, and ability to meet or exceed the required test parameters including strict contamination control, shroud temperature, and vacuum level,” said Jeff Kegley, chief of Marshall’s Science Test Branch. 
      The facility’s main chamber is 20 feet in diameter and 60 feet long, making it the 5th largest thermal vacuum chamber at NASA. It’s the only chamber that is adjoined to an ISO 6 cleanroom — a controlled environment that limits the number and size of airborne particles to minimize contamination. 
      The IMAP mission will launch on a SpaceX Falcon 9 rocket from NASA’s Kennedy Space Center in Florida, no earlier than September. 
      NASA’s IMAP mission was loaded into NASA Marshall’s XRCF thermal vacuum chamber where the spacecraft will undergo testing such as dramatic temperature changes to simulate the harsh environment of space. NASA/Johns Hopkins APL/Princeton/Ed Whitman Learn More about IMAP Media Contact:
      Lane Figueroa
      Marshall Space Flight Center
      Huntsville, Alabama
      256.544.0034
      lane.e.figueroa@nasa.gov
      Share
      Details
      Last Updated Apr 11, 2025 Related Terms
      Marshall Space Flight Center Goddard Space Flight Center Heliophysics Marshall Heliophysics & Planetary Science Marshall Science Research & Projects Marshall X-Ray & Cryogenic Facility The Sun The Sun & Solar Physics Explore More
      2 min read Hubble Captures a Star’s Swan Song
      The swirling, paint-like clouds in the darkness of space in this stunning image seem surreal,…
      Article 4 hours ago 6 min read NASA Webb’s Autopsy of Planet Swallowed by Star Yields Surprise
      Observations from NASA’s James Webb Space Telescope have provided a surprising twist in the narrative…
      Article 1 day ago 3 min read Hubble Helps Determine Uranus’ Rotation Rate with Unprecedented Precision
      An international team of astronomers using the NASA/ESA Hubble Space Telescope has made new measurements…
      Article 2 days ago Keep Exploring Discover More Topics From NASA
      Missions
      Humans in Space
      Climate Change
      Solar System
      View the full article
    • By NASA
      From left to right, NASA Marshall engineers Carlos Diaz and John Luke Bili, U.S. Naval Research Laboratory mechanical engineer contractor Eloise Stump, and Marshall engineers Tomasz Liz, David Banks, and Elise Doan observe StarBurst in the cleanroom environment before it’s unboxed from its shipping container. The cleanroom environment at Marshall is designed to minimize contamination and protect the observatory’s sensitive instruments. Image Credit: NASA /Daniel Kocevski   StarBurst, a wide-field gamma ray observatory, arrived at NASA’s Marshall Space Flight Center in Huntsville, Alabama, March 4 for environmental testing and final instrument integration. The instrument is designed to detect the initial emission of short gamma-ray bursts, a key electromagnetic indicator of neutron star mergers.
      “Gamma-ray bursts are among the most powerful explosions in the universe, and they serve as cosmic beacons that help us understand extreme physics, including black hole formation and the behavior of matter under extreme conditions,” said Dr. Daniel Kocevski, principal investigator of the StarBurst mission at NASA Marshall.
      According to Kocevski, neutron star mergers are particularly exciting because they produce gamma-ray bursts and gravitational waves, meaning scientists can study these events using two different signals – light and ripples in space time.
      Starburst Principal Investigator Dr. Daniel Kocevski, left, and Integration and Test Engineer Elise Doan, right, pose with the StarBurst instrument after it was unboxed in the cleanroom environment at NASA Marshall. The Naval Research Lab transferred the instrument to NASA in early March.Image Credit: NASA/Davy Haynes The merging of neutron stars forges heavy elements such as gold and platinum, revealing the origins of some of Earth’s building blocks.
      “By studying these gamma-ray bursts and the neutron star mergers that produce them, we gain insights into fundamental physics, the origins of elements, and even the expansion of the universe,” Kocevski said. “Neutron star mergers and gamma-ray bursts are nature’s laboratories for testing our understanding of the cosmos.”
      StarBurst will undergo flight vibration and thermal vacuum testing at Marshall in the Sunspot Thermal Vacuum Testing Facility. These tests ensure it can survive the rigors of launch and harsh environment of space.
      Final instrument integration will happen in the Stray Light Facility, which is a specialized environment to help identify and reduce unwanted light in certain areas of the optical systems.
      The StarBurst Multimessenger Pioneer is a wide-field gamma-ray observatory designed to detect the initial emission of short gamma-ray bursts, important electromagnetic indicators of neutron star mergers. With an effective area over five times that of the Fermi Gamma-ray Burst Monitor and complete visibility of the unobscured sky, StarBurst will conduct sensitive observations. NASA/Daniel Kocevski StarBurst is a collaborative effort led by NASA’s Marshall Space Flight Center, with partnerships with the U.S. Naval Research Laboratory, the University of Alabama Huntsville, the Universities Space Research Association, and the UTIAS Space Flight Laboratory. StarBurst was selected for development as part of the NASA Astrophysics Pioneers program, which supports lower-cost, smaller hardware missions to conduct compelling astrophysics science.
      To learn more about StarBurst visit:
      https://science.nasa.gov/mission/starburst/
      Media Contact:
      Lane Figueroa
      Marshall Space Flight Center
      Huntsville, Alabama
      256.544.0034
      lane.e.figueroa@nasa.gov
      View the full article
    • By NASA
      2 min read
      Preparations for Next Moonwalk Simulations Underway (and Underwater)
      A NASA F/A-18 research aircraft flies above California near NASA’s Armstrong Flight Research Center in Edwards, California, testing a commercial precision landing technology for future space missions. The Psionic Space Navigation Doppler Lidar (PSNDL) system is installed in a pod located under the right wing of the aircraft.NASA Nestled in a pod under an F/A-18 Hornet aircraft wing, flying above California, and traveling up to the speed of sound, NASA put a commercial sensor technology to the test. The flight tests demonstrated the sensor accuracy and navigation precision in challenging conditions, helping prepare the technology to land robots and astronauts on the Moon and Mars. 
      The Psionic Space Navigation Doppler Lidar (PSNDL) system is rooted in NASA technology that Psionic, Inc. of Hampton, Virginia, licensed and further developed. They miniaturized the NASA technology, added further functionality, and incorporated component redundancies that make it more rugged for spaceflight. The PSNDL navigation system also includes cameras and an inertial measurement unit to make it a complete navigation system capable of accurately determining a vehicle’s position and velocity for precision landing and other spaceflight applications. 
      NASA engineers and technicians install the Psionic Space Navigation Doppler Lidar (PSNDL) system into a testing pod on a NASA F/A-18 research aircraft ahead of February 2025 flight tests at NASA’s Armstrong Flight Research Center in Edwards, California.NASA The aircraft departed from NASA’s Armstrong Flight Research Center in Edwards, California, and conducted a variety of flight paths over several days in February 2025. It flew a large figure-8 loop and conducted several highly dynamic maneuvers over Death Valley, California, to collect navigation data at various altitudes, velocities, and orientations relevant for lunar and Mars entry and descent. Refurbished for these tests, the NASA F/A-18 pod can support critical data collection for other technologies and users at a low cost. 
      Doppler Lidar sensors provide a highly accurate measurement of speed by measuring the frequency shift between laser light emitted from the sensor reflected from the ground. Lidar are extremely useful in sunlight-challenged areas that may have long shadows and stark contrasts, such as the lunar South Pole. Pairing PSNDL with cameras adds the ability to visually compare pictures with surface reconnaissance maps of rocky terrain and navigate to landing at interesting locations on Mars. All the data is fed into a computer to make quick, real-time decisions to enable precise touchdowns at safe locations. 
      Psionic Space Navigation Doppler Lidar (PSNDL) system installed in a testing pod on a NASA F/A-18 research aircraft ahead of February 2025 flight tests at NASA’s Armstrong Flight Research Center in Edwards, California.NASA Since licensing NDL in 2016, Psionic has received funding and development support from NASA’s Space Technology Mission Directorate through its Small Business Innovative Research program and Tipping Point initiative. The company has also tested PSNDL prototypes on suborbital vehicles via the Flight Opportunities program. In 2024, onboard a commercial lunar lander, NASA successfully demonstrated the predecessor NDL system developed by the agency’s Langley Research Center in Hampton, Virginia. 
      Explore More
      4 min read NASA Starling and SpaceX Starlink Improve Space Traffic Coordination
      Article 10 mins ago 6 min read How NASA’s Perseverance Is Helping Prepare Astronauts for Mars
      Article 36 mins ago 2 min read NASA Cloud Software Helps Companies Find their Place in Space 
      Article 20 hours ago Facebook logo @NASATechnology @NASA_Technology Share
      Details
      Last Updated Mar 26, 2025 EditorLoura Hall Related Terms
      Armstrong Flight Research Center Game Changing Development Program Space Communications Technology Space Technology Mission Directorate Technology Technology for Living in Space Technology for Space Travel View the full article
  • Check out these Videos

×
×
  • Create New...