Updates to NASA’S Break-in-Prebreathe Flight Rules Due to Type II Decompression Sickness Risk Considerations

Investigation of a central neurological decompression sickness (DCS) case during hypobaric ground testing at Johnson Space Center (JSC) identified a ~3 min break-in-prebreathe (BiP) late in the prebreathe (13 min prior to depressurization) as the leading credible cause for the DCS case. This occurred despite applicable prebreathe payback rules being followed. Applicable NASA rules, for ground and flight, directed 2:1 payback of breaks up to 10 min in duration, regardless of when a break occurs relative to depress. Breaks lasting longer than 10 min require a complete restart of the prebreathe protocol. The adequacy of NASA’s BiP rules was evaluated prior to resuming any hypobaric ground testing or International Space Station (ISS) extravehicular activity (EVA).

Of particular interest to the authors was the timing of the BiP in relation to the overall prebreathe timeline. Although there exists no agreed-upon definition, a ‘late’ BiP means towards the end of the prebreathe period, and in particular, the last hour prior to depressurization.

The following information sources were reviewed prior to formulating recommendations: i) the type II DCS case report and findings from the investigation; ii) documented rationale for existing flight rules, iii) consultations with subject matter experts involved in definition of existing flight rules (several of whom had since left NASA); iv) relevant published literature; v) tissue gas loading model estimates; and vi) NASA’s operational experience with late breaks in prebreathe.