Abstract
BackgroundPerformance of cardiopulmonary resuscitation (CPR) causes significant mental stress for rescuers, especially if performed by inexperienced individuals. Our aim was to study electrocardiogram (ECG) alterations in rescuers and its association with gender and CPR performance.MethodsWe included 126 medical students in this prospective, observational simulator study. Each student was equipped with a 3-lead continuous ECG device tracking the individual electrocardiographic output before, during and after CPR. We analyzed variations in heart rate, heart-rate variability (HRV) and ST- and T-wave morphology.ResultsCompared to baseline, mean heart rate (bpm) significantly increased during resuscitation and again decreased after resuscitation (from 87 to 97 to 80, p<0.001). Heart-rate variability (the standard deviation of all N-N intervals, SDNN) (ms2) showed the opposite pattern, decreasing during resuscitation and increasing after resuscitation (117 to 92 to 93ms, p<0.001). Abnormalities in T-waves and ST-segments were observed in 29.4% of participants. Maximal heart rate (r = 0.25, p = 0.046) as well as heart rate reactivity (r = 0.7, p<0.001) correlated with hands-on time, a measure of CPR performance. Compared to males, female rescuers had a significantly higher maximal heart rate (136bpm vs. 126bpm, p = 0.008) and lower HRV (SDNN 102 vs. 119ms, p = 0.004) and tended to show more abnormalities in T-waves and ST-segments (36% vs. 21%, p = 0.080).ConclusionCPR causes significant ECG alterations in healthy medical students with ST-segment and T-wave abnormalities, with more pronounced effects in females. Clinical implications of these findings need to be further investigated.
Highlights
A cardiac arrest is an emergency situation that causes mental stress to all involved rescuers
Stress activates the sympathetic nervous system. These factors lead to a physiological response to acute mental stress in healthy subjects, which includes an increase in cardiac output, heart rate and systemic vascular resistance and an increase of cardiac afterload [2, 3]
We investigated dynamics of different ECG parameters before, during and after resuscitation using an analysis of variance (ANOVA)
Summary
A cardiac arrest is an emergency situation that causes mental stress to all involved rescuers. The extent of stress-response to an acute stressor and the individual appraisal of an emergency situation shows a high inter-individual variability and is influenced by genetic factors, age, environment and gender [1]. These factors lead to a physiological response to acute mental stress in healthy subjects, which includes an increase in cardiac output, heart rate and systemic vascular resistance and an increase of cardiac afterload [2, 3]. Performance of cardiopulmonary resuscitation (CPR) causes significant mental stress for rescuers, especially if performed by inexperienced individuals. Our aim was to study electrocardiogram (ECG) alterations in rescuers and its association with gender and CPR performance
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