Abstract

ObjectiveTo assess how stressful conditions in endotracheal intubation could induct emotional excitation in a population of acute care physicians.Materials and methodsTwo situations were randomly tested: one in standard and easy intubation conditions the other under difficult conditions presumed to induce stress (monitoring alarms, manikin lying on the floor, difficult intubation). Emotional excitation was assessed using several physiological (cardiac patterns, electrodermal activity and eye-tracking) and psycho-cognitive patterns. Auto-evaluations of video recordings and mental workload were performed immediately after simulation.ResultsSignificant physiological parameter modifications were observed under the stressful intubation conditions (SDNN 35 ± 15 vs. 42 ± 21; p = 0.035—AVNN 514 ± 94 vs. 548 ± 110; p < 0.0001). Emotional excitation was demonstrated to lead a higher mental workload (NASA-TLX = 39 ± 18 vs. 63 ± 15; p = 0.001), frustration and effort dimensions being its determinant components (p < 0.01). Video recording auto-evaluations depicted significant emotional excitation occurrence under the difficult conditions, with few differences according to the operator’s experience.ConclusionThis study highlights the fact that a stress condition during ETI on a simulation model leads to an important emotional excitation as compared to the neutral condition.

Highlights

  • IntroductionIn emergency medicine (EM), anesthesiology and critical care, it is a challenging procedure associated with severe life-threatening complications, including cardiac arrest

  • Endotracheal intubation (ETI) is a standard procedure for the airway management

  • Significant physiological parameter modifications were observed under the stressful intubation conditions (SDNN 35 ± 15 vs. 42 ± 21; p = 0.035—average of RR intervals (AVNN) 514 ± 94 vs. 548 ± 110; p < 0.0001)

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Summary

Introduction

In emergency medicine (EM), anesthesiology and critical care, it is a challenging procedure associated with severe life-threatening complications, including cardiac arrest. These complications vary according to the operator expertise and depend on several factors, notably in prehospital EM, i.e., unstable medical conditions, environmental requirements, unknown patient medical history [1] and emotional excitation. Technical skills training has traditionally been modeled on an apprenticeship system, where trainees operated under direct supervision from their seniors. Over recent years, this system has evolved, taking into account security concepts developed in the aerospace sector with simulation and healthcare guidelines from national authorities [2, 3]. Simulation is increasingly used in this setting, and different learning programs exist between juniors and seniors [4]

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