Astronauts tap into telehealth to treat a blood clot

A new case study published in the New England Journal of Medicine runs through how astronauts employed telemedicine to get the right medications to a patient in space.
By Laura Lovett
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Telehealth is now reaching some of the most remote places on the planet, and even beyond just Earth. Recently the New England Journal of Medicine published a case study outlining a situation when telehealth came into practice in outer space. 

Two months into a six-month space journey, a NASA astronaut was undergoing an ultrasound on the International Space Station (ISS) when a potential blood clot or obstructive left internal jugular venous thrombosis was found. 

Using telemedicine, doctors onboard the ISS performed a follow-up ultrasound with the help of two radiologists on Earth. After the blood clot was confirmed, a team of multiple physicians on Earth evaluated the patient. 

“Normally the protocol for treating a patient with [deep vein thrombosis] would be to start them on blood thinners for at least three months to prevent the clot from getting bigger and to lessen the harm it could cause if it moved to a different part of the body such as the lungs,” Dr. Stephan Moll, a faculty member at the UNC School of Medicine, who worked on the case said in release from the school. “There is some risk when taking blood thinners that if an injury occurs, it could cause internal bleeding that is difficult to stop. In either case, emergency medical attention could be needed. Knowing there are no emergency rooms in space, we had to weigh our options very carefully.”

Eventually the doctors decided to treat the patient with blood thinner, but the medications were restricted by what was available onboard. The team started the patient on Enoxaparin, which was available onboard, and was able to send up a shipment of Apixaban, according to an announcement from UNC Medical. 

The patient was asymptomatic six months after returning to Earth. 

 “This case of venous thromboembolism in space flight highlights unique complexities of space medicine, such as the need for non-evidence-based clinical decision making; the need for patient-performed, radiologist-guided telemedicine ultrasonography; and a limited pharmacy in which long-term anti-coagulation is not supported, syringes are a limited commodity, and drawing liquids from vials is a significant challenge because of surface-tension effects,” authors of the correspondence wrote. “Medical decisions in this case were implemented through concerted efforts across multiple space agencies to overcome the numerous logistic and operational challenges.”

WHY IT MATTERS 

NASA has plans to put an astronaut in Mars in the not-so-distant future. However, the mission to Mars will mean a trip longer than anything ever accomplished before. 

“So, the round trip to mars is nearly three years, and maybe one of [the crew] will be a physician and they are going to have to contend over that long duration mission far away from Earth without any possibility of return or abort, or any ways of replacing broken parts with normal health concerns,” Dorit Donoviel, director at Translational Research Institute for Space Health, said at the Space Health Innovation Conference in October. 

Since the ISS is considerably closer to Earth than the Moon or Mars, traditionally NASA has used the station to test out new devices and tools. 

“One of the great things we can do on the space station is to test new technologies — kind of kick the tires, be sure it is working the way we want and be sure it is going to meet our needs when we go to Mars,” Julie Robinson, chief scientist at the ISS division for NASA's human exploration and operations, told MobiHealthNews. 

THE LARGER TREND 

Employing telemedicine for remote care has been a concept circulating in the medical community for more than a decade. While the example of space health will only impact a very niche community, it does demonstrate its uses in extreme circumstances. Space health stakeholders have continually touted how tools used in space can be in turn used on earth.  

 “When you think about it, it’s really for humans exploring deep space on behalf of all of humanity. Everything that we do creates a new way to do healthcare,” Donoviel said. 

Today providers and government agencies are both looking to telemedicine to fill another kind of remote areas with a focus on rural health. Over the summer the FCC’s Connected Care Pilot Program, which would offer major discounts to providers establishing broadband-based telehealth programs, sought public comment on its rural telehealth pilot. Additionally, the US Department of Agriculture announced new grant investments in late November for infrastructure aimed at expanding education and healthcare access among rural US residents. However, telehealth has been slow to catch on in many remote areas.  

ON THE RECORD 

“When the astronaut called my home phone, my wife answered and then passed the phone to me with the comment, ‘Stephan, a phone call for you from space.’ That was pretty amazing,” Moll said in the UNC announcement. “It was incredible to get a call from an astronaut in space. They just wanted to talk to me as if they were one of my other patients. And amazingly the call connection was better than when I call my family in Germany, even though the ISS zips around Earth at 17,000 miles per hour.”