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Heart Rate Variability and Acute Stress Among Novice Airway Managers
Author(s) -
Mefford Jason M.,
Kahle Sarah,
Gupta Shikha,
Tancredi Daniel,
Danielson Aaron R.,
Clarke Samuel O.
Publication year - 2019
Publication title -
aem education and training
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 9
ISSN - 2472-5390
DOI - 10.1002/aet2.10335
Subject(s) - intubation , heart rate variability , medicine , anxiety , heart rate , anesthesia , physical therapy , emergency medicine , blood pressure , psychiatry
Background The nature of medical emergencies places emergency physicians at risk for high levels of acute psychological stress ( APS ). Stress‐modifying techniques like visualization, breath control, and mental practice may help mitigate APS , but objective markers of stress are difficult to measure in the clinical setting. We explored the relationship between heart rate variability ( HRV ), a real‐time measure of autonomic arousal, and self‐reported APS among emergency medicine ( EM ) residents learning to intubate on actual patients. Methods This was a prospective study of postgraduate year 1 ( PGY ‐1) EM residents at a single academic medical center during their 1‐month anesthesia rotation. We obtained repeated measures of HRV immediately before and during the first intubation attempt each day. Participants completed the modified Spielberger State‐Trait Anxiety Inventory ( STAI ‐6) before intubation attempts and scored intubation difficulty using the Intubation Difficulty Scale. We analyzed HRV using root mean square of successive differences and analyzed data using clustered data methods and Pearson correlation coefficients. Results We enrolled eight PGY ‐1 residents and recorded 64 intubations. Mean HRV in the 2 minutes before intubation (17.88 ± 9.22) and during intubation (21.17 ± 13.46) was significantly lower than resting baseline (32.09 ± 15.23; adjusted mean difference [95% CI ] = –13.90 [–20.35 to –7.45], p < 0.001; and –10.77 [–17.65 to –3.88], p = 0.02). Preintubation anxiety was negatively correlated with HRV (r = –0.39 [–0.58 to –0.16], p = 0.001). Intubation difficulty was not significantly correlated with HRV (r = –0.12 [–0.36 to 0.13], p = 0.35). Conclusions HRV shows promise as a real‐time index of autonomic arousal and may serve as an outcome measure in the evaluation of stress‐modifying interventions.