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ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial

AIMS: Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhyt...

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Autores principales: Maleczek, Mathias, Schebesta, Karl, Hamp, Thomas, Burger, Achim Leo, Pezawas, Thomas, Krammel, Mario, Roessler, Bernhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288087/
https://www.ncbi.nlm.nih.gov/pubmed/35841049
http://dx.doi.org/10.1186/s13049-022-01033-1
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author Maleczek, Mathias
Schebesta, Karl
Hamp, Thomas
Burger, Achim Leo
Pezawas, Thomas
Krammel, Mario
Roessler, Bernhard
author_facet Maleczek, Mathias
Schebesta, Karl
Hamp, Thomas
Burger, Achim Leo
Pezawas, Thomas
Krammel, Mario
Roessler, Bernhard
author_sort Maleczek, Mathias
collection PubMed
description AIMS: Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field. METHODS: In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. RESULTS: Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. CONCLUSION: ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2
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spelling pubmed-92880872022-07-17 ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial Maleczek, Mathias Schebesta, Karl Hamp, Thomas Burger, Achim Leo Pezawas, Thomas Krammel, Mario Roessler, Bernhard Scand J Trauma Resusc Emerg Med Original Research AIMS: Due to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field. METHODS: In this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed. RESULTS: Data from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index. CONCLUSION: ECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation. Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2 BioMed Central 2022-07-15 /pmc/articles/PMC9288087/ /pubmed/35841049 http://dx.doi.org/10.1186/s13049-022-01033-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Research
Maleczek, Mathias
Schebesta, Karl
Hamp, Thomas
Burger, Achim Leo
Pezawas, Thomas
Krammel, Mario
Roessler, Bernhard
ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title_full ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title_fullStr ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title_full_unstemmed ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title_short ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial
title_sort st-t segment changes in prehospital emergency physicians in the field: a prospective observational trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9288087/
https://www.ncbi.nlm.nih.gov/pubmed/35841049
http://dx.doi.org/10.1186/s13049-022-01033-1
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