Introduction/Background Anesthesia providers are required to manage emergency situations all over the hospital. Clinicians are generally notified of a crisis without prior warning and expected to arrive within minutes, to rapidly assess the situation and to act immediately and appropriately while still under physical stress from running to the site of the emergency. The necessary measures to respond to the emergency typically require short and long term memory, executive function and technical manual skills. There are conflicting reports in the literature if physical stress affects these skills and if it does so in a positive or negative way.1-8 We therefore designed a study to test the hypothesis that physical stress alters the response of providers to an emergency. Methods The Hypothesis of this study was that physical stress prior to management of a simulated crisis influences clinician performance. The following Specific Aims were investigated: 1) To determine whether the physical stress of running to a crisis affects clinician cognitive performance; 2) To determine whether the physical stress of running to a crisis affects clinician technical performance. Anesthesia providers were prospectively randomized to undergo either physical stress (PS) or no physical stress (NPS) prior to managing one of two randomly assigned simulated operating room crisis events. Physical stress was induced by running a defined distance (1/8 mile at 5% incline) on a treadmill. Running speed was left at the discretion of the provider. Vital signs (HR, RR, SpO2, BP) were recorded before and after the exercise and task performance periods. Both simulated crises incorporated measures of cognitive challenges (short term memory using al list of 10 diagnoses and key factors of the diagnoses) and technical tasks (intubation), as well as focus and executive function (memorizing key parameters of the procedure and the case vignette). At least two weeks later, the same clinicians were subjected to the other scenario (either physical stress or no physical stress) prior to managing the other simulated crisis event. Power analysis indicated a necessary sample of 34 subjects with a power of 80% and a significance level of 0.05. Results Forty subjects were recruited, 38 subjects completed the study. Average running times of 123 (54)s at a speed of 4.86 (1.70) mph were recorded. This caused average heart rate increases from baseline 70 (12)s-1 to 123 (30) s-1 compared to performing the procedure without exercise. The differences in the time that the subjects needed to perform the intubation task after stress was 36 (19)s vs. 37 (18)s (p+ n.s.) without stress. Providers forgot non-significantly more diagnoses from the patient’s history after physical stress (1.56 vs.1.38 parameters; p=n.s.). This trend was more pronounced but not statistically significant (p<0.1) in the 20% of the subjects who took longest to run the distance. There were no significant differences for the subgroups trainee status, first year of training, years of experience, age above 50, CRNA or MD, age, gender, or heart rate percentiles. Conclusion Our Results indicate that both technical and cognitive performance is maintained in the setting of moderate physical stress when providers are allowed to run at their own speed to the site of the intervention. Further research is needed to determine if different degrees of physical and other stress will cause impediment in technical skills and cognitive function. References 1. Gothe N, Pontifex MB, Hillman C, McAuley E. The Acute Effects of Yoga on Executive Function. J Phys Act Health. 2012. 2.Huertas F, Zahonero J, Sanabria D, Lupianez J. Functioning of the attentional networks at rest vs. during acute bouts of aerobic exercise. J Sport Exerc Psychol. 2011;33(5):649-65. 3. Lambourne K, Audiffren M, Tomporowski PD. Effects of acute exercise on sensory and executive processing tasks. Med Sci Sports Exerc. 2010;42(7):1396-402. 4. Audiffren M, Tomporowski PD, Zagrodnik J. Acute aerobic exercise and information processing: modulation of executive control in a Random Number Generation task. Acta Psychol (Amst). 2009;132(1):85-95. 5. Audiffren M, Tomporowski PD, Zagrodnik J. Acute aerobic exercise and information processing: energizing motor processes during a choice reaction time task. Acta Psychol (Amst). 2008;129(3):410-9. 6. Coles K, Tomporowski PD. Effects of acute exercise on executive processing, short-term and long-term memory. J Sports Sci. 2008;26(3):333-44. 7. Harvey A, Bandiera G, Nathens AB, Leblanc VR. Impact of Stress on Resident Performance in Simulated Trauma Scenarios. J Trauma. 2011. 8. Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during U.S. Navy SEAL training. Sea-Air-Land. Psychopharmacology (Berl). 2002;164(3):250-61. Disclosures None.
Vivian Lee, Abby Fitzgerald, Lily Victoria Ver
Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare