Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature

Vincent, Alessia; Semmer, Norbert K.; Becker, Christoph; Beck, Katharina; Tschan, Franziska; Bobst, Cora; Schuetz, Philipp; Märsch, Stephan; Hunziker, Sabina

doi:10.1016/j.jcrc.2020.09.020

Cited by 29 publications

(28 citation statements)

References 72 publications

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“…Our results resonate with previous findings showing that ED provider's multitasking was associated with increased mental workload [31]. However, due to mounting workload, stress during ED work might also be part of a feedback system with positive as well as negative effects on current performance and subsequent adjustments in ED operations [41,42].…”

Section: Discussionsupporting

confidence: 90%

“…Since we observed particularly during phases of low or medium cognitive load and everyday ED care, our findings may pertain to times of routine work that allow for efficient task switching under opportune moments [24,26]. Available literature on ED stress and SA has been focused on high-demanding emergency care task with immense efforts that overburden provider cognition and mitigate situation awareness, i.e., resuscitation, overcrowding [18,41,42]. Moreover, laboratory studies suggest that medium levels of discretionary task switching may spur productivity, nonetheless, at the cost of accuracy [27].…”

Section: Discussionmentioning

confidence: 89%

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Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Augenstein

Schneider

Wehler

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Multitasking is a key skill for emergency department (ED) providers. Yet, potentially beneficial or debilitating effects for provider functioning and cognition are underexplored. We therefore aimed to investigate the role of multitasking for ED physicians’ work stress and situation awareness (SA). Methods Two consecutive, multi-source studies utilizing standardized expert observations in combination with physicians’ self-reports on stress and SA were set out in an academic ED. To control for ED workload, measures of patient acuity, patient counts, and ED staff on duty were included. Regression analyses estimated associations between observed proportion of time spent in multitasking with matched ED physicians’ reports on stress (study 1) and SA (study 2). Results ED physicians engaged between 18.7% (study 1) and 13.0% (study 2) of their worktime in multitasking. Self-reported as well as expert-observed multitasking were significantly associated. This confirms the internal validity of our observational approach. After controlling for ED workload, we found that physicians who engaged more frequently in multitasking perceived higher work stress (Beta = .02, 95%CI .001–.03; p = .01). In study 2, ED physicians with more frequent multitasking behaviors reported higher SA (B = .08, 95%CI .02–.14; p = .009). Conclusions Multitasking is often unavoidable in ED care. Our findings suggest that ED physicians’ multitasking increases stress experiences, yet, may facilitate professional’s experiences of situation awareness. Our results warrant further investigation into potentially ambivalent effects of ED providers’ multitasking in effectively sharing time between competing demands while maintaining performance and safety.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 89%

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Augenstein

Schneider

Wehler

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…Quantification of the acute stress response of rescuers during CPR has been the subject of many studies, although no single stress-specific marker for its measurement has been definitively validated [ 70 ]. Thus, previous studies have used, alone or in conjunction, different surrogate stress markers (ie, biological, electrophysiological or psychological) to assess the relationship between stress and CPR performance [ 11 ]. Those considering subjective stress markers by means of self-reported questionnaires, such as the STAI, showed the strongest association with lower performance [ 6 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Evaluations and decisions must be made quickly and accurately. However, acute mental stress experienced by rescuers during CPR may impair decision making and optimal performance [4][5][6][7][8][9][10][11][12], independent of professional experience [4]. This can, in turn, adversely affect patient safety [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial

Lacour

Bloudeau²,

Combescure

et al. 2021

JMIR Mhealth Uhealth

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Background Out-of-hospital cardiac arrests (OHCAs) are stressful, high-stake events that are associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services. Children are particularly vulnerable to such errors. To date, no app has been validated to specifically support emergency drug preparation by paramedics through reducing the stress level of this procedure and medication errors. Objective This study aims to determine the effectiveness of an evidence-based mobile app compared with that of the conventional preparation methods in reducing acute stress in paramedics at the psychological and physiological levels while safely preparing emergency drugs during simulated pediatric OHCA scenarios. Methods In a parent, multicenter, randomized controlled trial of 14 emergency medical services, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario in an 18-month-old child. The primary outcome was participants’ self-reported psychological stress perceived during sequential preparations of 4 intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, and sodium bicarbonate) with the support of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory and Visual Analog Scale questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of the participants’ heart rate with optical photoplethysmography. Results From September 3, 2019, to January 21, 2020, 150 advanced paramedics underwent randomization. A total of 74 participants were assigned to the mobile app (intervention group), and 76 did not use the app (control group). A total of 600 drug doses were prepared. Higher State-Trait Anxiety Inventory–perceived stress increase from baseline was observed during the scenario using the conventional methods (mean 35.4, SD 8.2 to mean 49.8, SD 13.2; a 41.3%, 35.0 increase) than when using the app (mean 36.1, SD 8.1 to mean 39.0, SD 8.4; a 12.3%, 29.0 increase). This revealed a 30.1% (95% CI 20.5%-39.8%; P<.001) lower relative change in stress response in participants who used the app. On the Visual Analog Scale questionnaire, participants in the control group reported a higher increase in stress at the peak of the scenario (mean 7.1, SD 1.8 vs mean 6.4, SD 1.9; difference: −0.8, 95% CI −1.3 to −0.2; P=.005). Increase in heart rate during the scenario and over the 4 drugs was not different between the 2 groups. Conclusions Compared with the conventional method, dedicated mobile apps can reduce acute perceived stress during the preparation of emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. Trial Registration ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-019-3726-4

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“…Despite the fact that stress has previously been shown to have adverse effects on overall performance, the question remains to what extent stress affects performance in CPR. 6 Bjørshol et al demonstrated no effect on CPR quality of trained, experienced personnel when performing CPR in the presence of socioemotional stress. 7 However, physical fatigue appears to negatively affect the quality of CPR, resulting in inadequate chest compressions and ventilations.…”

Section: Introductionmentioning

confidence: 99%

Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation

Torsy

Deswarte

Traav

et al. 2021

Nursing in Critical Care

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Background: In-hospital cardiac arrest is a medical emergency that occurs on a regular basis. As patients most at risk for an in-hospital cardiac arrest are usually positioned on a dynamic mattress, it is important to measure the effect of mattress compressibility on chest compression quality during cardiopulmonary resuscitation (CPR).High-quality CPR is essential for patient survival and good neurological outcome. Aims and objectives: To examine the effect of an inflated dynamic overlay mattress on chest compression quality during CPR and to explore the predictive effect of health care providers' anthropometric factors, hand positioning and mattress type on chest compression frequency and depth. Design: Manikin-based single-blinded randomised controlled trial. Methods: Nursing students (N = 70) were randomised to a control (viscoelastic foam mattress) or intervention group (inflated dynamic overlay mattress on top of a viscoelastic foam mattress) and had to perform chest compressions over a 2-minute period. Compression rate, depth and hand positioning were registered. The 2015 European Resuscitation Council (ERC) guidelines were used as a reference.Results: The mean difference in chest compression depth between control and intervention groups was 2.86 mm (P = .043). Both groups met the guidelines for adequate chest compression quality, as recommended by the ERC. A predictive effect of health care providers' body height and weight, mattress type and hand positioning on compression depth could be demonstrated (P = .004).Conclusions: CPR in bedridden patients on a dynamic overlay mattress has a negative effect on the quality of chest compressions. Mean chest compression depth decreases significantly. However, clinical significance of the results may be debatable.

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Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature

Cited by 29 publications

References 72 publications

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Multitasking behaviors and provider outcomes in emergency department physicians: two consecutive, observational and multi-source studies

Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: Study Nested Within a Multicenter Randomized Controlled Trial

Effect of a dynamic mattress on chest compression quality during cardiopulmonary resuscitation

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