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By NASA
5 min read
Preparations for Next Moonwalk Simulations Underway (and Underwater)
In-person participants (L-R) – Back row: Jason Lytle, Stuart Lee, Eric Bershad, Ashot Sargsyan, Aaron Everson, Philip Wells, Sergi Vaquer Araujo, Steven Grover, John A. Heit, Mehdi Shishehbor, Laura Bostick; Middle row: Sarah Childress Taoufik, Stephan Moll, Brandon Macias, Kristin Coffey, Ann-Kathrin Vlacil, Dave Francisco; Front row: James Pavela, Doug Ebert, Kathleen McMonigal, Esther Kim, Emma Hwang; Not pictured: Tyson Brunstetter, J. D. Polk
Online participants: Stephen Alamo, Mark Crowther, Steven Nissen, Mark Rosenberg, Jeffrey Weitz, R. Eugene Zierler, Serena Aunon, Tina Bayuse, Laura Beachy, Becky Brocato, Daniel Buckland, Jackie Charvat, Diana Cruz Topete, Quinn Dufurrena, Robert Haddon, Joanne Kaouk, Kim Lowe, Steve Laurie, Karina Marshall-Goebel, Sara Mason, Shannan Moynihan, James Pattarini, Devan Petersen, Ruth Reitzel, Donna Roberts, Lucia Roccaro, Mike Stenger, Terry Taddeo, Gavin Travers, Mary Van Baalen, Liz WarrenNASA In October 2024, NASA’s Office of the Chief Health and Medical Officer (OCHMO) initiated a working group to review the status and progress of research and clinical activities intended to mitigate the risk of venous thromboembolism (VTE) during spaceflight. The working group took place over two days at NASA’s Johnson Space Center; a second meeting on the topic was held in December 2024 at the European Space Agency (ESA) facility in Cologne, Germany.
Read More about the Risk of VTE The working group was assembled from internal NASA subject matter experts (SMEs), the NASA OCHMO Standards Team, NASA and ESA stakeholders, and external SMEs, including physicians and medical professionals from leading universities and medical centers in the United States and Canada.
Background
Spaceflight Venous Thrombosis (SVT)
Spaceflight Venous Thrombosis (SVT) refers to a phenomenon experienced during spaceflight in which a thrombus (blood clot) forms in the internal jugular vein (and/or associated vasculature) that may be symptomatic (thrombus accompanied by, but not limited to, visible internal jugular vein swelling, facial edema beyond “nominal” spaceflight adaptation, eyelid edema, and/or headache) or asymptomatic. Obstructive thrombi have been identified in a very small number of crewmembers, as shown in the figure below.
Note that the figure below is for illustrative purposes only; locations are approximate, and size is not to scale.
Approximate location of identified thrombi in crewmembers.Source: Modified from Cerebral Sinus Venous Thrombosis – University of Colorado Denver With treatment, crewmembers were able to complete their mission, and anticoagulants were discontinued several days prior to landing to minimize the risk of bleeding in the event of a traumatic injury. Some thromboses completely resolved post landing, and some required additional treatment.
Pathophysiology of Venous Thromboembolism (VTE)
The proposed pathogenesis of VTE is referred to as Virchow’s triad and suggests that VTE occurs as the result of:
Alterations in blood flow (i.e., stasis), Vascular endothelial injury/changes, and/or, Alterations in the constituents of the blood leading to hypercoagulability (i.e., hereditary predisposition or acquired hypercoagulability). Note: pathophysiology are the changes that occur during a disease process; hypercoagulability is the increased tendency to develop blood to clots.
The Virchow’s triad of risk factors for venous thrombosis.Bouchnita, 2017 Blood stasis, or venous stasis, refers to a condition in which the blood flow in the veins slows down which leads to pooling in the veins. This slowing of the blood may be due to vein valves becoming damaged or weak, immobility, and/or the absence of muscular contractions. Associated symptoms include swelling, skin changes, varicose veins, and slow-healing sores or ulcers. In terrestrial medicine, venous thrombosis is typically caused by damaged or weakened vein valves, which can be due to many factors, including aging, blood clots, varicose veins, obesity, pregnancy, sedentary lifestyle, estrogen use, and hereditary predisposition.
Spaceflight Considerations
Altered Venous Blood Flow and Spaceflight Associated Neuro-ocular Syndrome
In addition to the terrestrial risk factors of VTE, there are physiological changes associated with spaceflight that are hypothesized to potentially play a role in the development of VTE in weightlessness. Specifically, researchers have explored the effects of the microgravity environment and subsequent observed headward fluid shifts that occur, and the potential impact on blood flow. Crewmembers onboard the International Space Station (ISS) experience weightlessness due to the microgravity environment and thus experience a sustained redistribution of bodily fluids from the legs toward the head. The prolonged headward fluid shifts during weightlessness results in facial puffiness, decreased leg volume, increased cardiac stroke volume, and decreased plasma volume.
Crewmembers have also experienced altered blood flow during spaceflight, including retrograde venous blood flow (RVBF) (the backflow of venous blood towards the brain) or stasis (a stoppage or slowdown in the flow of blood). While the causes of the observed stasis and retrograde blood flow in spaceflight participants is not well understood, the potential clinical significance of the role it may have in the development of thrombus formation warrants further investigation.
Doppler imaging of a retrograde flow in the left internal jugular vein.Yan & Seow, 2009 Other physiological concerns affected by fluid shifts are being studied to consider if any relation to VTE exists. Chronic weightlessness can cause bodily fluids such as blood and cerebrospinal fluid to move toward the head, which can lead to optic nerve swelling, folds in the retina, flattening of the back of the eye, and swelling in the brain. This collection of eye and brain changes is called “spaceflight associated neuro-ocular syndrome,” or SANS. Some astronauts only experience mild changes in space, while others have clinically significant outcomes. The long-term health outcome from these changes is unknown but actively being investigated. The risk of developing SANS is higher during longer-duration missions and remains a top research priority for scientists ahead of a Mars mission.
Conclusions and Further Work
Based on expert opinion and the assessment of the risk factors for thrombosis, an algorithm was developed to provide guidance for in-mission assessment and treatment of thrombus formation in weightlessness. The algorithm is based on early in-flight ultrasound testing to determine the flow characteristic of the left internal jugular vein and associated vasculature.
NASA Working Group Recommendations
The working group recommended several areas for further investigation to assess feasibility and potential to mitigate the risk of thrombosis in spaceflight:
Improved detection capabilities to identify when a thrombus has formed in-flight, Pathophysiology/factors leading to thrombi formation during spaceflight, Countermeasures and treatment
For more information on the working group meeting and a complete list of references, please see the Risk of Venous Thromboembolism (VTE) During Spaceflight Summary Report.
Risk of Venous Thromboembolism (VTE) During Spaceflight Summary Report Share
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Last Updated Mar 14, 2025 EditorKim Lowe Related Terms
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By NASA
Center Director Dr. Jimmy Kenyon gives an overview of NASA Glenn Research Center’s areas of expertise and how it supports the agency’s missions and programs. Credit: NASA/Susan Valerian NASA Glenn Research Center’s Director Dr. Jimmy Kenyon and Chief Counsel Callista Puchmeyer participated in a local symposium that addressed the operational and legal challenges of human spaceflight. The one-day conference was held at the Cleveland State University (CSU) College of Law on Feb.13.
Kenyon gave a keynote that provided an overview of NASA Glenn’s areas of expertise and how the center supports the agency’s missions and programs. He also talked about the role of growing commercial partnerships at NASA.
Panelists, left to right: Col. (Ret.) Joseph Zeis, senior advisor for Aerospace and Defense, Office of the Governor of Ohio; Callista Puchmeyer, chief counsel, NASA’s Glenn Research Center; and Jon. P. Yormick, international business and trade attorney, Yormick Law, answer questions on operational and legal challenges of human spaceflight at a Cleveland State University College of Law symposium. Credit: NASA/Susan Valerian Puchmeyer, a graduate of CSU’s College of Law and recent inductee into its Hall of Fame, participated in a panel about Northeast Ohio’s aerospace industry and the legal aspects of commercial partnerships.
Additionally, human spaceflight experts from academia, law, and science spoke throughout the day on topics ranging from the health and training of astronauts to the special law of space stations. Romanian astronaut Dumitru-Dorin Prunariu joined remotely to provide a personal perspective.
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By NASA
1 min read
Preparations for Next Moonwalk Simulations Underway (and Underwater)
Astronaut Serena M. Auñón-Chancellor Examines Her Eyes in SpaceNASA Exposure to altered gravity can cause ocular and brain structural changes to develop during spaceflight; these changes could lead to vision alterations, cognitive effects, or other deleterious health effects. SANS is a syndrome unique to humans that fly in space, and there is no terrestrial disease equivalent. Brain structural changes appear small but seem to indicate that over half of crewmembers experience one or more symptoms of SANS. Determining intracranial pressure during spaceflight could improve our understanding of SANS mechanisms and improve our ability to target countermeasures for determining risk for future missions.
NASA astronaut Karen Nyberg, Expedition 36 flight engineer, conducts an ocular health exam on herself in the Destiny laboratory of the Earth-orbiting International Space Station. (NASA)NASA Directed Acyclic Graph Files
+ DAG File Information (HSRB Home Page)
+ SANS Risk DAG and Narrative (PDF)
+ SANS Risk DAG Code (TXT)
Human Research Roadmap
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Human System Risks Share
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Last Updated Mar 11, 2025 EditorRobert E. LewisLocationJohnson Space Center Related Terms
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By NASA
6 min read
Preparations for Next Moonwalk Simulations Underway (and Underwater)
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).
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.
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:
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). Describe risks and benefits of PFO screening in astronaut candidates, current crewmembers, and chamber test subjects. 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? 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:
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). 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. 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. 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.
Summary Report About the Author
Sarah D. Childress
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Last Updated Dec 31, 2024 Related Terms
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By European Space Agency
On 4 December 2024, the European Space Agency (ESA) and the Indian Space Research Organisation (ISRO) signed an agreement that will see ESA provide ground station support to the missions in ISRO’s Gaganyaan human spaceflight programme.
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